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Tracing the Source: The symptoms of smallpox are not recorded in pre-Qin ancient books. Therefore, tracing its origin and source results in many undecided views. Some claim it is caused by ingesting foul blood while in the womb; others attribute it to the accumulation of desire fire during intercourse. These are generally considered "fetal toxins" (Tai Du, toxins inherited from the fetus). Since the Song and Yuan dynasties, most physicians have held similar views. Recently, however, some have argued that epidemic febrile diseases (Tian Xing Yi Li) are identical to cold damage (Shang Han), implying they are external contractions unrelated to fetal toxins. This is incorrect. Not everyone contracts cold damage, whereas smallpox is unavoidable for everyone. After contracting cold damage, one cannot guarantee against reinfection; but after smallpox erupts once, it never recurs. Thus, the concept of "fetal toxin" holds true. However, ingesting foul substances or desire fire has existed since the beginning of humanity. Why was this not seen before the Han Dynasty, but only appeared after the Jianwu era? Was there truly no fetal toxin before Jianwu? The answer is: initially, all cases of smallpox are rooted in fetal toxins; ultimately, all cases are formed through external contractions. Because they are rooted in fetal toxins, everyone is susceptible; because they are formed by external contractions, they specifically appeared after the Jianwu era and were absent before. The Classics state: "Uneven warmth and heat produce sores." In ancient times, when customs were pure and constitution strong, even if fetal toxins existed, they could be internally resolved. In cold regions, where pores are closed and tight, epidemics struggle to invade; in warm regions with peaceful climates, sores do not form. Hence, smallpox was unheard of. By the Jianwu period, people from the extreme northwest (Hu tribes) moved to the warm southern regions. Their pores opened, and they accidentally contracted the qi of seasonal epidemics, which stirred up the warm-heat toxins received in the womb, causing these sores. Those infected could not escape, and thus smallpox became established. Similarly, the common "yangmei chuang" (syphilis-like sore) also arose in modern times, is contagious, and does not recur after eruption, just like smallpox. Humans exist within the intersection of qi; therefore, smallpox caused by external contractions is generally contagious. If the initial trigger is prevented, the disease does not manifest. One cannot adhere to a single theory. Only when internal fetal toxins and external pathogens clash does the disease form. At the very beginning, before red spots appear, applying mild sweating methods to disperse the pathogen invariably leads to recovery. Missing this opportunity to induce sweating, until the stage of impending eruption, the momentum is already set. Attempting sweating at this point will cause deficiency types to fail to form pus, and excess types to develop into severe macules. How can one not be prudent?

Smallpox begins with fetal toxins, followed by contraction of epidemic external pathogens, which stir up latent toxins. The situation spreads like a prairie fire, extremely dangerous, contagious, and harmful to the common people. Therefore, Yu Shi wrote about it. Smallpox erupts due to warm epidemics; treating it according to the six meridians of external contraction allows for treatment during non-epidemic periods to achieve perfect results. Wan Muzhai expressed this most precisely, Guan Cheng also did well, and the supplementary formulas in *Dou Zhen Ding Lun* are particularly excellent. Recently, inoculation methods (Yin Zhong Fa), pioneered by Jenner (Zhan Na Shi), have proven nearly infallible. They are practiced only in Guangdong and have not yet spread globally. People in Jiangsu and Zhejiang are half-believing and half-doubting; it is a pity that minds are not open. Alas! If one can treat external epidemic contractions, one can treat smallpox. Yu Shi pioneered this approach out of sincere compassion for saving lives, but ignorant vulgarities fail to understand.

Note: The cowpox inoculation method is now widespread.

Prevention: Preventive medicines, such as the ancient formulas You Yin Zi, Chen Sha San, and Long Gu Gao, are often used without effect. Is it really impossible to prevent smallpox beforehand? However, "treating disease before it arises" is knowledge physicians should possess. Therefore, whenever weather is abnormal, local smallpox outbreaks occur, or winter warmth causes sudden leakage of yang qi, leading to large-scale eruptions in spring and summer, one should preemptively use blood-cooling and fire-descending medicines. This may reduce severe cases to mild ones, or mild ones to none. Perhaps this principle holds. I hereby attach an experienced formula below:

Dai Tian Xuan Hua Wan (Pill to Announce Heaven's Will)
Ren Zhong Huang (Earth element, Sovereign herb in Jia/Ji years) Huang Qin (Metal element, Sovereign herb in Yi/Geng years) Huang Bo (Water element, Sovereign herb in Bing/Xin years)
Zhi Zi (Wood element, Sovereign herb in Ding/Ren years) Huang Lian (Fire element, Sovereign herb in Wu/Gui years) Ku Shen (Assistant) Jing Jie Sui (Assistant) Fang Feng
(removed rhizome, Assistant) Lian Qiao (removed heart, wine-washed, Assistant) Zi Su Ye (Assistant) Niu Bang Zi (wine-rinsed, fried, Assistant) Shan Dou Gen (Assistant)
First, determine the elemental year, selecting the corresponding herb as the Sovereign. The remaining annual rulers serve as Ministers. The Sovereign herb dosage is doubled; the Minister herb dosage is halved; the Assistant herb dosage is three-quarters of the Minister. Process on the Winter Solstice day into powder. Use snow water to decoct Sheng Ma, mix with Zhu Li (bamboo sap), and blend with Shen Qu to form pills. Coat externally with Chen Sha (Cinnabar) and Xiong Huang (Realgar). Administer with Zhu Ye Tang (Bamboo Leaf Decoction). (Note: Even if ineffective, this formula causes no harm.)

Method for Preparing Ren Zhong Huang: Take large Gan Cao (Licorice Root), any amount. Insert into a section of fresh bamboo, tightly sealing empty spaces without nodes. Soak in a urine vat for 77 days. Remove, dry, and store for use. Xiao Du Dan, Chen Sha (washed), Si Gua (near the stem, 3 cun, burned until charred but retaining nature, powdered). Mix equal parts.
For infants under one year: 1 qian; over one year: 2 qian. Mix with honey and administer. Alternatively, boil pigeon or rooster, apply Chen Sha to the meat, and let the child eat it. This is also acceptable.
The above two formulas mainly focus on cooling blood. My friend Sun Yuanbo uses Sheng Di Huang (Rehmannia Root), Jin Yin Hua (Honeysuckle Flower), and Chuan Shan Jia (Pangolin Scale) as main herbs, which is also excellent. These two herbs cool blood, while Pangolin Scale traverses both water and land, guiding the other herbs through the collaterals without obstruction.

If the spleen and stomach are inherently weak, it is better to regulate stomach qi, adapt to cold and heat, and control milk and food intake. Occasionally administer Liu Jun Zi Tang (Six Gentlemen Decoction) added with Zhi Shi (Immature Bitter Orange), Sha Ren (Amomum Fruit), and Mu Xiang (Aucklandia Root) to harmonize stomach qi and promote circulation of Ying and Wei qi. This facilitates eruption and scabbing. If constitutional yuan qi is deficient, prioritize tonifying the source of transformation, slightly adding blood-cooling herbs like Sheng Di Huang and Jin Yin Hua. Once qi and blood are robust, even strong toxins pose no threat. Avoid excessive use of cooling and resolving agents; the key lies in flexibility.

In years before smallpox epidemics, or during abnormal weather and epidemic propagation, preemptively taking blood-cooling and fire-descending medicines reduces the release of latent toxins, thereby alleviating latent pathogens. This is indeed effective. While staying in a capital inn, I met Mr. Mo Pu'er from Yunnan, who came to take the imperial examination. He mentioned a "Divine Emperor Bean" in his region. Worshipping and offering it prevents smallpox in streets it passes through, or spares those infected from death. It is truly a divine object, said to be planted by Shennong. He gifted me one bean; testing proved it effective. This information is rarely known by the public; I record it here.

On Smallpox Originating from Foot Taiyang: Smallpox symptoms generally evolve from the Foot Taiyang Meridian. Although smallpox is not strictly an external contraction, it erupts due to external factors, so Yang meridians are affected first, similar to cold damage. Qian’s school states each organ has a specific sign: yawning and stretching indicate Liver; frequent palpitations indicate Heart; alternating cold and heat with cold limbs indicate Spleen; red cheeks, coughing, and sneezing indicate Lung. Kidney alone shows no signs because it is located inferiorly and does not accept filth. This view is plausible but flawed. Smallpox toxins are severe, but they enter via meridians. Unless it is a critical condition, how could toxins directly enter the organs? As for Kidney showing no signs, it is because the ears, sacrum, and feet tend to feel cold. Smallpox is fire toxin, while Kidney is a Water organ; Water controls Fire, so Fire does not invade. It is not because Kidney rejects filth. During fetal development, Kidney connects to the fetus throughout, governing life from start to finish. If filth/toxin exists, Kidney should receive it first. Then, how do we know it starts from Foot Taiyang? Answer: *Ling Shu · Kou Wen Pian* treats yawning, stretching, and sneezing by supplementing Foot Taiyang, indicating these are Taiyang signs. *Su Wen* states: Excessive water qi leads to cold pathogen prevalence, causing vexation, irritability, and palpitations. Cold water reverses up the spine, counteracting Bing Fire (Heart/Small Intestine), representing cold pathogen prevalence. Cold water reversing onto the face causes red cheeks. Thus, palpitations and red cheeks are also Taiyang signs. Cough and fever/chills correspond to early cold damage and are common; no one immediately diagnoses them as organ disease based solely on this. Question: If it is like cold damage and comes from Taiyang, why are there no headache, stiff neck, or joint pain symptoms? Answer: This belongs to warm-heat diseases. The nature of infection differs, so syndrome differentiation differs.

Smallpox erupts when external contractions stir latent toxins. Taiyang is the meridian connecting the whole body; thus, Yang meridians are affected first, starting inevitably from Taiyang, which is natural logic. Western scientist Jenner invented inoculation to drain toxicity from Hand Shaoyang. Post-inoculation, recurrence never happens, making it an excellent method.

On Sweating and Purging: When smallpox has not erupted and diagnosis is uncertain, do not recklessly use sweating or purging medicines. Reckless sweating empties the exterior, making eruption difficult; reckless purging empties the interior, leading to collapse. However, this advice applies to standard cases, emphasizing precision. If wind-cold attacks externally, preventing eruption, sweating agents are applicable. If constipation persists for days accompanied by restlessness and mania, failing to purge would endanger life; thus, purgatives are applicable. Furthermore, situations extend beyond this (Clarify exterior/interior, distinguish deficiency/excess. Exterior requires sweating, interior requires purging. Correct imbalances, turn danger to safety. This is the balance of treatment methods and the subtlety of deficiency/excess). *Ti Ren Hui Bian* states: For adverse smallpox, use Bao Yuan Tang added with Niu Bang Zi, Huang Qin, Huang Lian, Xuan Shen, Si Gua Hui, Xiong Duan, Dang Gui, Lian Qiao (each 5 fen), Chen Pi, Gui Zhi (3 fen), Bai Shao Yao (1 qian), Fang Feng, Qiang Huo, Jing Jie, Qian Hu (each 3 fen). Decoct with Ginger and Scallion to induce sweating, draining toxin and opening stagnation. If after 7-8 days, the condition is severe with white color and deep toxin, use Bao Yuan Tang combined with Da Huang, Mang Xiao, Zhi Shi, Hou Po, Xiong Duan, Dang Gui decocted in water for strong purging. Otherwise, interior deficiency causes toxin to attack inward; sweating an interior condition causes exterior deficiency, making toxin harder to exit. If qi and blood are sufficient, even strong toxins cannot overcome them; sweating and purging drain toxins, and the disease resolves. If qi and blood are deficient and toxins prevail, sweating is forbidden for the deficient. Even if toxins are drained, survival is impossible, resulting only in accusations of murder. Precision is essential.

Differentiating Deficiency and Excess: Anorexia, shortness of breath, abdominal distension, vomiting and diarrhea indicate Interior Deficiency. Modify Si Jun Zi Tang; for severe cases, use Mu Xiang San. The opposite indicates Excess; no medicine needed. If organ heat is severe, with constipation, dark urine, abdominal fullness and wheezing, sweating palms and axillae, delirium, thirst for fluids, appetite but failure to scab, use Cheng Qi Tang to purge. Cool body, non-red pustule bases, and depressed tops indicate Exterior Deficiency. Modify Xiao Jian Zhong Tang; for severe cases, use Yi Gong Tang. The opposite indicates Excess; no medicine needed.
Vomiting/diarrhea, shortness of breath, abdominal distension = Interior Deficiency. Abdominal fullness/wheezing, constipation/urinary retention, delirium/thirst = Interior Excess. Careful discussion clearly distinguishes deficiency and excess.

Assessing Severity: Mild fever implies light toxin, resulting in mild initial eruption signs; heavy fever implies heavy toxin, resulting in severe signs. Mild cases need no special treatment. Severe cases require initial exterior resolution, followed by blood cooling and toxin detoxification. Once erupted, warm-tonify qi and blood to assist pus formation and scabbing. Failure to treat at this stage renders treatment useless after six days. Be prudent and cautious! Red veins appearing behind both ears, bright and lustrous, indicate mild smallpox. Purple-red veins appearing dull and dark indicate severe smallpox. Bright red veins with slight purple tint but lustrous appearance indicate severe smallpox that will resolve safely. For the latter two, urgently administer detoxifying and blood-cooling medicines to transform severity into mildness.
Observing red veins behind the ears to distinguish severity is the most obvious and accessible method.