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The eruption of smallpox is a great tribulation for infants. Before the Han Dynasty, this disease did not exist. During the Yuanshuo era of Emperor Wu of Han, envoys were sent to the Uyghurs, and the disease was transmitted from there into China. The pathogenic qi has a foul and turbid odor that is difficult to approach. Only among those of high status and virtue do black smallpox eruptions occasionally appear; this is extremely rare.

Zhu Xizhou (courtesy name Jinggong) of Kunshan had smallpox in his childhood. Every pustule was black, resembling a bundle of strips tied around his waist. All physicians declared it incurable. One physician, however, recognized the condition and said to Zhu's father, "Your son's condition poses no threat. However, I wish to make an agreement with you: I have a daughter, and after his recovery, I would like your son to marry into my family." Zhu agreed, and he subsequently became a live-in son-in-law. This physician was already wealthy and provided all necessary expenses. Later, Zhu passed the imperial examination as the top scholar (Zhuangyuan) in the Bingchen year of the Hongzhi reign, rose to the position of Minister of Rites, and became a renowned official in ritual and music. He lived to be ninety-four years old and was posthumously titled "Jing".

Zhang Daquan treated the son of Y Quanbu when he was a child. The boy had died from smallpox. Zhang examined him and said, "He is not dead." He urgently ordered a pit to be dug in the ground, placed the child inside, and took several buckets of fresh water. Using paper soaked in water, he applied it heavily to the child's body. After a short while, fine smoke rose, and the child's hand moved slightly. Zhang rejoiced, saying, "He is alive." He poured more water on the child, causing steam to rise vigorously, and the child cried loudly several times. Upon taking him out and administering medicine, he recovered within a few days.

Wang Min treated Shen Zhi, a Qianhu (military officer), who was twenty years old. Shen suddenly experienced dizziness, vertigo, and delirious speech, accompanied by fever and cough. Other physicians treated him for cold damage (Shanghan). Wang said, "This is smallpox." He prescribed Shengjun Tang, after which the eruptions appeared.

Ge Maolin diagnosed the son of Wang Bibu, who was twenty-five years old. He suddenly contracted smallpox. Wang, being knowledgeable about medicine, believed there was no danger. Ge looked grave. By the fifth day, the eruptions had fully emerged; by the seventh day, they had crusted over. Ge remained grave. On the fourteenth day, the scabs fell off, and Wang believed his son was safe. Ge said, "Disaster will likely occur at one month." When that time arrived, his son was perfectly fine. Wang hosted a grand banquet, seemingly mocking Ge's prediction. Ge observed blisters on the soles of the boy's feet, with scars forming within the skin, and sighed, "Alas! He is doomed." On that very day, the boy died suddenly. Wang considered Ge divine and asked for the reason. Ge explained, "Smallpox represents the residual filth left after the formation of the body. If even a tiny trace of toxin remains, there is no hope for life. This disease originates from the Kidney, and I knew it could not discharge smoothly, hence death was certain. Later, it flowed to the soles of the feet, which caused the slow onset but inevitable outcome on this day." Wang sighed in admiration.

Shen Haowen treated the adopted daughter of Shen Qinyun, aged ten. Her younger brother had smallpox, and she carried him to seek medical treatment. Shen said, "The brother is unharmed, but the sister will develop malignant smallpox. If she experiences headache and bone pain, she should drink clear urine (Fenqing)." Following this advice, she recovered.

Tang Shouyuan treated the son of Lady Zhu of Yuanhua. The boy suffered from smallpox with blood eruptions covering his entire body without any gap. Tang crushed herbs and applied them to the boy's body, sprinkled herbal powder on the bedding, rolled the boy up, and held him upside down before the bed. The whole family wept in horror. Tang shouted, "Do not be alarmed. This is called 'Snake Skin Smallpox.' It must be treated inversely to escape danger." Soon, the skin cracked and separated like a snake shedding its skin, and he recovered.

Guan's daughter, Aguan, was eight years old and had many severe smallpox eruptions. Dr. Shen asked, "What do other doctors say?" They replied, "It is a fatal case; no medicine is needed." Shen said, "Although the child has many dead eruptions, there is one living eruption, which can still save her." He ordered a hen that had been brooding chicks for five years to be taken. Medicine was inserted into the hen's abdomen, and the hen was steamed with glutinous rice until consumed. Upon examination, two eruptions were found on the Guan pulse of the right hand, bright and vivid like pearls. The girl survived.

Jiang Lutao's son was one year old, with only three smallpox eruptions appearing on the forehead, behind the ears, and beside the lips. Shen said, "The location of the eruptions indicates a reverse transmission through the Heart, Kidney, and Spleen meridians. Earth overcomes Water, and Water overcomes Fire. Treatment should focus on purging rather than tonifying. Purging disperses the toxin, while tonifying harms the zang-fu organs." By the fourteenth day, the eruptions were bright and moist, nearing maturity. Shen said, "Using Gypsum (Shigao) might injure Stomach Earth and Kidney Water." Unorthodox physicians, pitying the young child, mistakenly administered Ginseng (Renshen). Shen exclaimed in shock upon seeing this, "Ginseng? He will not survive past twenty-one." The child eventually died.

Xu Jiming's youngest son had smallpox. Shen said, "This is a favorable course; no tonification is needed. Children possess pure Yang energy; excessive Yang inevitably suppresses Yin." Xu did not comply. The smallpox healed, and Xu mocked Shen as reckless. Shen predicted, "The child will soon die." Xu was displeased. On the twelfth day, while the child was sleeping soundly, he was found deceased.

Pan recorded a case: A girl suffered from fever, lower back pain, cold extremities, and dull eyes. The symptoms were extremely severe, suggesting impending smallpox. It was summer, so pig blood from a butcher was urgently obtained. Dragon Brain (Bingpian/Borneol) was added in double dosage, mixed, and ingested. The girl fell asleep. Shortly after, eruptions appeared all over her body, and she stabilized. Without this prescription, she would have died prematurely. (From *Bencao Gangmu*).

Chen Po from Kuocang recounted that when he was teaching in Sanshan, his grandson, aged three, had a seven-day fever. Smallpox erupted but inverted (daoye), with black coloration, white lips, and icy coldness. A scholar advised using seven houseflies (Gouying) ground finely, mixed with a little vinegar wine. After a while, the complexion returned to normal redness. His second daughter developed internal cataracts due to toxin attacking upwards after smallpox. A physician used one snake skin, washed and dried, mixed equally with Trichosanthes Root (Tianhuafen), ground into powder, stuffed into a sheep liver, bound with hemp rope, boiled in rice wash water, and eaten in slices. She recovered in ten days. (From *Yiju Lu*. Houseflies are abundant in summer; in winter, they hide in ears.)

Zhao Shenxian from Fugou transmitted the "Revive the Dead Powder" (Qisi Huisheng San) for treating smallpox on the seventh or eighth day when eruptions suddenly turned black and receded into the abdomen, with scratching wounds all over, gasping, and imminent death. Taking this powder causes new eruptions to emerge, restoring life immediately. The formula uses Siwu Tang plus Cimicifuga (Shengma) and Safflower (Honghua). For upper inversions, add Angelica Dahurica (Baizhi); for lower inversions, add Achyranthes (Niuxi); for full-body black inversions, add Ephedra (Mahuang) and roasted elephant dung. Dosage: 2 qian for a one-year-old, up to 3-5 qian for older children. Decoct one dose in half water and half wine. For black boils on the feet, puncture on the seventh/eighth day, apply Taiyi Plaster to draw out toxin, continuing 2-3 doses.

Zhu Danxi treated a seven-year-old boy. At the stage just before smallpox eruption, he had diarrhea several times with black stool. The eruptions lacked distinct bases. After three days, itching occurred; scratching released black fluid. The child was thirsty, and the bases resembled vesicles, non-red, non-shiny, and undeveloped. Appetite was poor. The pulse was floating, rapid, and forceful, but empty upon deep pressure. Zhu used Ginseng (Renshen), Poria (Fuling), Angelica Sinensis (Danggui), Atractylodes (Baizhu), Tangerine Peel (Chenpi), and Myristica (Roudoukou) as sovereign herbs; Roasted Licorice (Zhi Gancao), Chebula (Hezi), and Cinnamon Twig (Guizhi) as minister/herald herbs. Decocted in water with a little good wine. Itching stopped immediately, appetite returned, bases became red and shiny, and eruptions developed. Two doses resulted in full recovery.

Gong Zicai treated a girl whose smallpox had swollen and was about to suppurate when it suddenly turned purple-black and bled upon scratching. This indicated excessive heat toxin. He used Mirabilite (Pinxiao) in unspecified amounts, boiled with a pinch of Sichuan Pepper (Huajiao). Green cloth soaked in the solution was frequently applied to the affected area for a long time, restoring swelling and appearance.

Sun Wen yuan treated the eldest son of Zheng Duojian, aged four, with dense, irritable smallpox. Physicians claimed excessive heat persisted, wasting physique, purple color, and scorched tops, indicating a hopeless adverse condition. Sun examined closely, noting round temples and vigorous spirit (indicating potential for life). He prescribed urgent cooling of blood and detoxification: Red Peony Root (Chishao) and Rehmannia (Shengdi) 3 qian each, Arnebia/Lithospermum (Zicao) 2 qian, Forsythia (Lianqiao), Scutellaria (Huangqin), Fritillaria (Beimu), Hawthorn (Shanzha), and Akebia (Mutong) 1 qian each, Cicada Slough (Chantui) and Licorice (Gancao) 0.5 qian each. Others objected, stating "Measles require cooling, smallpox require warming." Sun argued, "Medicine must match the syndrome. Baoyuan Tang is warm, but suitable only after blood circulation improves and heat clears. With current blood heat and toxin, warming agents are adding oil to fire." Others suggested using Silkworm (Sangchong) with chicken blood wine to "attack toxin with toxin." Sun warned this would intensify fire if used before clearing heat. Zheng complied with Sun's initial formula (minus Shanzha and Beimu per others' advice). Next day, eruptions became bright, scorched tops receded, and blood flow improved. Vomiting and hiccups ensued, blamed on the medicine by others. Sun attributed it to residual fire toxin and prescribed Bamboo Shavings Decoction (Zhuru Tang), causing uproar. Zheng's brother verified Zhuru usage in *Douzhen Quanshu*, silencing critics. Hiccups ceased. On day eight, diarrhea and itching appeared; Baoyuan Tang plus White Peony (Baishao), Atractylodes (Baizhu), and large amounts of Polygonatum (Shouwu) stopped diarrhea and itching. By day fourteen, Tian Ting and cheeks crusted, but cheeks remained unclosed with persistent diarrhea. Half a day later, mouth opened, crown soft, limbs collapsed, abdomen distended—internal attack. Family wept; Sun was at a loss and left. Zheng's brother escorted him. Hearing a smallpox odor on Sun's clothes, Zheng asked if he smelled it. Sun said yes, noted signs of life, and urged return. He reasoned the unclosed cheeks indicated Kidney deficiency. He first gave Human Placenta (Ziheche) 1 qian with wine, inducing sleep. Then, a large dose of Ginseng (Renshen) 1 liang, Astragalus (Huangqi) and Dodder Seed (Tusizi) 3 qian each, administered over 24 hours (totaling 1.8 liang Ginseng). Yellow serum reappeared under crusts ("gifted pus"), and he recovered. (Note: This case highlights Qi deficiency with Blood heat and stagnant Stomach Qi. Adding Radix Puerariae (Gegen) to cooling formulas aids Stomach Qi; adding Ginseng and Astragalus boosts Qi. This method belongs to Zhao Gongfu. Sun initially lacked this insight, causing delays.)

Yu Jiayan diagnosed Gu Ming's son immediately after variolation. The vaccine material was pale red, distinct, containing moisture, bright, and sparse. Other doctors praised it as a "Top Scholar Smallpox," unaware of underlying issues. After hesitation, Gu Ming reported: Heat not yet suppressed, heavy head, weak neck, restlessness, irritability, green-white diarrhea. This is seasonal external contraction combined with internal deficiency. Standard smallpox formulas would be dangerous. One or two doses to resolve external contraction would allow spontaneous cure. Delaying two or three days would be fatal. They ignored this, feeding shrimp, fish, chicken, and eruptive foods, worsening the condition. The child deteriorated by day six, confirming the prognosis. Two days later, the second son also developed fever and smallpox with seasonal invasion, treated by the same doctor, and failed by day six.

Feng Chuzhan treated the grandson of Jiang Zongxian. Smallpox was not dense, but congenital weakness was severe. High fever, profuse sweating, and retreating flat eruptions over four days, with lethargy and fright. Feng stated: High fever indicates Yang outside; sweating indicates Yin leaking and Yang failing to consolidate. Tonify Yin, nourish Yang, and strengthen the Middle. Formula: Rehmannia (Shudi) 8 qian, Atractylodes (Baizhu) stir-fried in milk 3 qian, Achyranthes (Niuxi) 8 qian, Ophiopogon (Maidong) 2 qian, Schisandra (Wuweizi) 0.4 qian, Cinnamon Bark (Rougui) 0.6 fen. Decocted. Within an hour, deep sleep, cool body, sweat stopped, spirit refreshed, eruptions rose, appetite returned, and he recovered.

A Hu family child had critical smallpox initially. An old doctor predicted death. Feng Chuzhan was invited. The previous prescription was excessively cooling, causing stagnation and eruption failure, with wheezing and abdominal distension. Feng first used fermented rice wine and rooster comb blood with Dusheng San to break the ice-like stagnation. Wheezing and heat decreased, and eruptions showed signs of emerging. The opposing doctor argued for inevitability of death. Feng insisted on collaboration. The father wept daily but allowed treatment. Eight or nine out of ten recovered, but the father remained unhappy, having been told repeatedly that death was imminent. Only upon complete scabbing did the father show joy, regretting his earlier doubts.

Feng Chuzhan's fifth son, constitutionally weak, developed smallpox at age four. Fever for one to two days led to fatigue and profuse sweating. Eruptions appeared, but due to excessive sweating and Yang deficiency, dispersing agents were withheld. Beyond day three, sweating continued, frequent urination/defecation occurred, visible eruptions retreated, and unseen ones vanished. Formula: Ginseng (Renshen) and stir-fried Atractylodes (Baizhu) 3 qian each, Roasted Licorice (Zhi Gancao) 0.8 fen as sovereign (to secure Middle); Heavenly Silkworm (Tiancan) 3 qian, Thorny Acacia Spine (Jiaoci) 1 qian, Stir-fried Turtle Shell (Jiapian) 0.6 fen as ministers (to attack and support); Ligusticum (Chuanxiong) 0.8 fen to lift and disperse, Cinnamon Bark (Rougui) 0.6 fen to warm channels and reach exterior as assistants. Day four: Sweating/diarrhea reduced, some eruptions grew, hidden ones appeared. Added Angelica (Danggui) and Jujube (Dazao). Day five: Swelling began, slight pus formation in later eruptions. Facial eruptions were pale red without luster; back eruptions were purple, depressed, and dry, indicating Qi/Blood deficiency with stasis. Added Astragalus (Huangqi), Yam (Shanyao), Glutinous Rice (Nimi), and Longan (Yuanrou). Day six: Eruptions red and vibrant, but thin-skinned, shiny, with thin pus and limb blisters, indicating weak Qi/Blood and deficient Spleen Earth. Used Baoyuan Tang plus Cinnamon. Ginseng 5 qian (sovereign, tonifies primal Qi); Raw Astragalus 2 qian (minister, supplements Wei Qi); Roasted Licorice 0.6 fen, Glutinous Rice 1 zhua (assistants, soothe Middle, strengthen Stomach, brew pus); Cinnamon (envoy, unites vessels, supports). Day seven: Pus greatly increased; healed with a mild nurturing formula.

Wu Fuxian treated a boy whose smallpox turned gray-white after full eruption, with no pus formation for 7-8 days, loose stools, and anorexia. Critical condition. Formula: Ginseng, Deer Antler (Lurong), Processed Aconite (Zhi Fu), Cinnamon, Aucklandia (Muxiang), Silkworm (Sangchong), Human Tooth (Renya), Pangolin Scales (Shanjiapia), Thorny Acacia Spine, Saposhnikovia (Fangfeng), Platycodon (Jiegeng), Glutinous Rice. Decocted in decoction of Astragalus (Huangqi) 2 liang. First dose: pus base formed. Second dose: swelling rose. Third dose: sufficient pus.

A thirteen-year-old boy had dense smallpox. By days 8-9, approaching suppuration, every pustule was depressed into a pit. Muxiang Yigong San worsened the depression. Eruptions were red-purple, constitution strong. Diagnosis: Qi/Blood attempting to form pus, blocked by toxic vapors. Urgent detoxification required. Formula: Angelica (Danggui), Rehmannia (Shengdi), White Peony (Baishao), Arnebia (Zicao), Burdock (Niubang), Forsythia (Lianqiao), Platycodon (Jiegeng), Licorice (Gancao), Hawthorn (Shanzha), Astragalus (Huangqi), plus Wine-fried Scutellaria (Huangqin) and Coptis (Huanglian), Ginseng 0.3 fen. One dose raised depressions; two doses filled with pus.

A fourteen-year-old boy had fever after eruption. After 3-4 days, only faint spots appeared. Suddenly developed delirium. Cooling detoxifiers were tried. Pulse: slow and weak throughout. Eruptions: pale white. Diagnosis: Extreme deficiency mimicking excess. Weak Qi/Blood failed to expel toxin, causing delirium (distinct from excess heat mania). Administered warming and Qi-tonifying herbs. Eruptions spread, delirium stopped.

Wang Lusu stated: His grandson Mengpu had standard smallpox development and suppuration, but early resolution of pus. On day nine, a boil appeared on the left arm. Doctors used cooling detoxifiers. Within four doses, chills and teeth-grinding occurred. Doctors feared using Ginseng/Atractylodes due to toxin, relying only on Angelica/Astragalus with detoxifiers. Wang argued post-smallpox Qi/Blood deficiency, exacerbated by cold herbs damaging Spleen. Yang was severely deficient; Angelica/Astragalus alone insufficient, especially with cooling agents. He cited *Baoying Cuoyao* recommending Shiquan Dabu Tang for chills/teeth-grinding, or Xianfang Huoming Yin followed by Tuoli San for early boil stages. Insufficient Qi/Blood prevents suppuration/drainage. Wang prescribed Shiquan Tang for three doses to stop chills, then more to stop teeth-grinding. External treatment by a surgeon, internal use of Ginseng, Astragalus, Angelica, and White Peony continuously. Recovered in a month. During chills, arm swelling was severe; hesitation to use Ginseng/Atractylodes/Cinnamon was common. Wang concluded Lizhai's advice was correct, using large doses of Ginseng/Atractylodes and Cinnamon (5-6 fen), curing all symptoms. (Note: Lizhai has errors; do not rely solely on this.)

Zhou Huai's fourth son developed smallpox at 40+ days. Initially 3-4 spots on head/body, mild fever, normal nursing. Doctors predicted <100 spots. Zhou restricted wind and regulated diet. Two days later, density increased significantly on head, chest, abdomen, back, limbs, forehead, face, and scrotum (solid red, indistinct particles). Umbilicus had many protruding spots. Tongue had many white millet-like spots filled with pus. Doctors deemed it hopeless due to small size and many spots/adverse signs. Zhou observed red/vibrant color and good nursing ability, deeming it treatable. Worried about Qi/Blood exhaustion, he gave concentrated decoction of Ginseng, Astragalus, and Licorice, alternating with milk. Days 5-6: Head had much pus/blisters; body/limbs mostly blisters, few pus-pockets. Forehead/face solid red turned black once or twice, alarming Zhou as adverse. However, spirit and nursing remained intact. By midnight, scrotal scabs turned black. Zhou realized this was not evil due to young age allowing rapid Qi/Blood circulation; scabbing completed by day seven. By day eight (Yin/Mao hours), full body crusted. Day nine: Scabs fell off completely. Subsequently, high fever appeared due to incomplete toxin expulsion, leading to rapid scabbing/falling and impending carbuncle. Urgent detoxification with Dalianqiao Yin (half wine cup, slowly spoon-fed). Three cups overnight cleared fever. Nose scabs softened with honey, picked open with silver ear to release gas. Solid red areas with wet pus dusted with Phellodendron (Huangbai), Coptis (Huanglian), Licorice, Dogwood Root Bark (Digupi), and Chinese Gall (Wubeizi). Scrotal clear fluid treated with Cotton Cocoon Powder. All healed. (Note: Qi reached but Blood did not; lack of Blood-nourishing step left residual toxin.)

Zhou Huai's second daughter developed smallpox at age six. Fever was slow. By day two, faint spots on face/hands. By day four, spots remained, whitish, with fatigue, somnolence, and anorexia. Doctors saw few spots (<100). Zhou suspected otherwise: Few spots should mean clear spirit and normal appetite. Fatigue/anorexia/pale spots indicated Qi/Blood deficiency failing to expel toxin. Prescribed Wenzhong Yiqi Tang to support and expel. One dose: many hidden eruptions appeared. Two doses: majority erupted. Four doses in 24 hours: full body eruption, very dense. Cause: Previous fever/vomiting damaged Stomach Qi, requiring warming/support to erupt. Failure to recognize deficiency and expel toxin would lead to internal attack.