Library

Mr. Ba Shengmao lived in close proximity to my residence. His father, Mr. Bingzhao, had lost both his eldest and second sons to smallpox (Xiaodou). That spring, smallpox was prevalent, causing the death of many children. Mr. Ba Shengmao was only a few years old and had not yet contracted smallpox, which caused great worry for his father. One night, he suddenly developed fever (Fare) and vomiting (Ou Tu), with restless sleep. At dawn, Mr. Bingzhao came to invite me. Upon observation, I noted red cheeks (Jia Chi), dry lips (Chun Gan), body heat but cold fingers (Shen Re Zhi Leng), irritability and thirst (Fan Ke), and a yellow tongue coating (She Huang). Careful examination of the emerging rash spots revealed hidden purple-black discoloration (Zi Ban). I told Mr. Bingzhao: "This is a case of smallpox eruption obstruction (Bu Dou Bi Xian), a dangerous and adverse syndrome. Medication to dissipate the rash and promote its emergence may prevent danger." I prescribed Qianghuo San Decoction (Qianghuo San Tang) with added Gypsum Fibrosum (Shigao) and Juncus Effusus (Dengxin). In the afternoon, I visited again. Mr. Bingzhao reported that after taking the first decoction, the fever intensified, accompanied by mental restlessness and confusion, head shaking, and limb convulsions (Tou Yao Zhi Che). I said: "This indicates impending wind-stroke or convulsion (Jing Feng). Have him take the second decoction." By evening, the irritability and heat worsened significantly. He became comatose with delirious speech (Hun Chan), extremely thirsty and drinking water, with his tongue protruding outside the lips and unable to retract (She Tu Chun Wai), twitching incessantly. The rash still did not emerge and actually increased in number. The condition was severe, causing panic throughout the family. Bystanders suggested that the Gypsum in the prescription was too cooling, causing "ice-stagnation" (Bing Fu) harm. I declined this opinion. Mr. Bingzhao firmly requested treatment. Since we were neighbors with a good relationship, and since Mr. Ba Shengmao studied under my second son, I could not refuse out of courtesy. I explained: "Although medical texts state that early-stage smallpox should be treated with ascending and dispersing methods, avoiding cooling herbs to prevent ice-stagnation, this case involves excessive fire-toxin obstructing the Heart and Stomach, leading to rash obstruction. Without clearing the fire, how can the toxin dissipate? How can the rash emerge? The previous prescription's clearing power was too weak. Therefore, I will heavily use Gypsum as the sovereign herb, assisted by Rhinoceros Horn (Xijiao - *Note: Modern practice uses substitutes like Water Buffalo Horn*), wine-processed Coptis Chinensis (Jiu Chao Huanglian), Scrophularia Root (Yuanshen), Cimicifuga Rhizome (Shengma), Forsythia Fruit (Lianqiao), Red Peony Root (Chishao), Arctium Seed (Niubangzi), and Lithospermum Root (Zicao). Juncus tip serves as the guiding herb. Each dose should be taken with an additional flush of Wubi San, utilizing its hot nature to promote urination, embodying the principle of 'removing firewood from under the cauldron' (Fu Di Chou Xin)." After writing the prescription, I considered that the tongue is the sprout of the Heart. Given the persistent tongue protrusion, external application of Zi Xue Dan (Purple Snow Pill) on the tongue is necessary alongside internal decoction. However, this medicine is rare in our region. I asked neighbors for it, but the amount obtained was insufficient. Mr. Bingzhao said: "I have stored Zi Xue Dan for a long time." He took it out, weighed three qian, and felt relieved. I instructed him to mix it with honey and apply it to the tongue, and to quickly decoct and administer the medicine. The next morning, Mr. Bingzhao reported: "Last night, following your instructions, we administered the medicine and applied the tongue paste until midnight. The fever subsided, the rash receded, diarrhea stopped, and agitation settled. There seems to be a turning point." Upon re-examination, all symptoms had resolved, the toxin dissipated, and the rash emerged clearly. I said: "He has survived." Inquiry revealed only three fen of Zi Xue Dan remained, the rest having been applied. I smiled and said to Mr. Bingzhao: "Although this critical case was saved by the medication, such rapid efficacy would not have been achieved without such a large amount of Zi Xue Dan. Now that the fire energy is pacified, the medication should be relaxed. I will prescribe Shishen Jiedu Tang (Ten-God Detoxification Decoction), still using mild amounts of Gypsum and Rhinoceros Horn to clear residual fire. Then switch to Taiyi Baohe Tang, replacing Ginseng Radix (Renshen) with Glehnia Root (Shashen), adding Silkworm (Tianchong/Jiangcan), Angelica Dahurica (Baizhi), Fritillaria Bulb (Beimu), and fresh Lin (Xianlin - likely referring to fresh Dendrobium or similar yin-nourishing herb). Once the blisters form, tonify the Spleen and promote water metabolism, cool and detoxify, gradually achieving recovery. Such critical cases benefited from being neighbors, allowing daily monitoring and adjusting medications to the changing disease, thus preserving life. If the patient and doctor lived far apart, sudden changes would occur where even if one wished to help, one might be powerless. Seeking recovery would indeed be difficult."

An Bo commented: The prescription discussion is exquisite and divine; readers must not overlook it.