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[Xue Ji] The syndrome of fistula and sores (Lou Chuang) arises from congenital deficiency of Qi and Blood, or chronic illness leading to weakness of Qi and Blood, or internal heat due to food stagnation in the Liver and Spleen of the child, preventing the generation of muscle tissue, or emotional disharmony in the nursing mother causing the Spleen Qi to fail in its astringent function. One should investigate the etiology, tonify and regulate Yuan Qi, and assist with treatments such as Rusheng Biscuit (Rusheng Bing) and scallion moxibustion (Cong Yun). If one uses drugs that circulate Qi, break Blood, or cauterize/erode tissues, it will instead lead to a deteriorating condition; for other details, refer to the main principles in respective chapters.

Qian Yi stated: When the fetus is in the womb, by the sixth or seventh month, it has already taken form, consuming the turbid fluids of the mother which enter the five Zang organs. By the tenth month, these turbid fluids fill the stomach. At birth, there remains unclean matter in the infant's mouth. If the mother wipes it clean with her hand, no disease occurs. However, folk custom uses Coptis Rhizome (Huanglian) and Mercury Powder (Gfen) to purge the turbid meconium from the umbilicus. This introduces residual impure Qi from the mother into the infant's Zang organs. Originally caused by slight cold, combined with exposure to wind-cold, pathogenic factors clash, resulting in smallpox and chickenpox (Douzhen). Before the eruption begins, heat stirs the five Zang organs, so their symptoms appear first. Initially, when the disease is about to manifest, there are yawning, drowsiness, palpitations, alternating chills and fever, cold extremities, red and dry cheeks, coughing, and sneezing. These indicate that symptoms of all five Zang organs are present. Yawning and drowsiness relate to the Liver. Frequent palpitations relate to the Heart. Alternating chills and fever with cold extremities relate to the Spleen. Red face and cheeks with coughing and sneezing relate to the Lung. Only the Kidney shows no specific signs because it is located inferiorly and does not consume turbid fluids. All sores and rashes are toxins of the five Zang organs. If eruptions converge into one syndrome: Liver manifests as vesicles (Shui Pao), Lungs as pustules (Nong Pao), Heart as macules (Ban), Spleen as papules/rash (Zhen). Although the Kidney has no specific sign, if the prognosis is poor, with sores turning inward and becoming black and depressed, this indicates regression to the Kidney. This is caused by carelessness regarding wind-cold and inability to eat, leading to internal deficiency. Li Dongyuan said: The initial signs of rash eruption must include dry facial skin, red cheeks, red eyelids, yawning, drowsiness, alternating hot and cold, coughing, sneezing, slightly cold feet, excessive sleep, and waking startled. These are all signs of Douzhen. Whether large pustules, small red spots, or urticaria-like rashes appear, why do these upper symptoms precede the eruption? It is because Taiyang Cold Water originates below the right Kidney, simmering the left Kidney. Foot-Taiyang Bladder Cold Water flows counter-current along the spine, ascending to the head and forehead, reversing Hand-Taiyang Fire (Bing Fire) and preventing its transmission, rising to the face, thus displaying these symptoms. This is due to Ren-Gui Cold Water overcoming Bing-Ding Fire. All Douzhen syndromes emerge from counter-flowing Cold Water. Physicians must understand this principle before prescribing. The Bao Gong (Womb/Uterus), also called Chi Gong, Dan Tian, or Ming Men, stores essence and facilitates transformation in men, and receives conception in women. It is the source of life generation, not belonging to the Five Elements, neither Water nor Fire, but an alternative name for Heaven and Earth, symbolizing Kun Earth generating all things. At the beginning of human formation, after the Sea of Blood clears for one or two days, Essence overcomes Blood, resulting in a male. On the third, fourth, or fifth day, Blood vessels become vigorous, Essence fails to overcome Blood, resulting in a female. This is the interaction of two substances; what is born prior to the body is called Shen (Spirit) or Jing (Essence). During the ten months in the womb, the fetus breathes with the mother. Breathing is Yang Qi, promoting movement and nourishing Jing, Qi, and Shen. Hunger and thirst follow maternal blood. As the child grows daily, sinews, bones, flesh, blood vessels, form, and Qi become complete. Upon birth at ten months, foul blood remains in the mouth. With the first cry, inhalation draws it down; this foul blood returns to the Ming Men and Bao Gong, hiding in a corner, latent and inactive. Until the child suffers internal injury from milk/food or damp-heat sinking, combining with the Kidney, where two fires attack each other, Ying Qi fails to follow its course, reverses in the muscle layers, and the foul blood erupts. All rashes originate from Kidney Water. After ulceration, tissue regeneration returns to the Yangming channel. Thus, the initial signs involve Foot-Taiyang Ren Bladder overcoming Hand-Taiyang Bing Small Intestine. Eruptions initially appear on the face but ultimately return to Yangming muscle layers, where heat transforms into pus. When the two fires are blazing, they overcome Cold Water, causing eruptions over the whole body. This all stems from transmission via Foot-Taiyang. Wan Quan said: Regarding the origin of smallpox and chickenpox, some argue it is turbid toxin, others say excessive fire, others claim it is seasonal epidemic disease. There is no fixed theory. If it were turbid toxin or excessive fire, then within a year, whether in large counties or small villages, patients would be similar, and deaths would succeed one another, yet not everyone suffers so severely. If it were seasonal epidemic disease, why does it occur only once in a lifetime from youth to old age, with no subsequent contagion? Parents and children share one body divided; the toxicity of essence and blood accumulates from the beginning of Yang giving and Yin transforming. It does not wait until birth to swallow blood to create fetal toxin. Moreover, men conserve Qi to nourish Essence, while women expend Qi to nourish Blood. Once nourishment is lost, future ailments arise. Though what children inherit from parents differs, the nature of the toxin is the same. Is there really a principle that male excessive fire arising from Qi is Yang toxin and easy to treat, while female excessive fire arising from Blood is Yin toxin and difficult to treat? As for seasonal epidemic disease, it has its timing. Observing the annual influences and irregular Qi of the four seasons reveals such diseases. However, those that erupt according to time are fetal toxins. Some are rapid and critical, some slow and lingering, some sudden and fatal, depending on the strength of Qi. Once erupted, the toxin is released; hence, it occurs only once in a lifetime. Even if the pathogen exists later, there is no further contagion. That smallpox is a fetal toxin is evident. Among them, some are sparse and mild, some dense and severe, some severe turning mild, some mild turning severe. Changes are unpredictable. There is another explanation. Sparse and mild cases remain consistent throughout. Dense and severe cases exhibit myriad variations. This may be due to transmission from parents, infection by epidemics, or attachment by ghostly pathogens (Gu Zhu). These phenomena are obscure, beyond ordinary perception and thought. Discuss this with the wise; do not speak dreams to fools. Why? Because the toxin of Douzhen originally resides in the parents. Even after having suffered it once, residual toxins remain in the Zang organs, meridians, skin, muscles, and bone marrow. Upon separation of form and transformation of Qi, injecting into the child, the toxin is also excreted. Therefore, the scars of children often resemble those of their parents. Coupled with improper care and unrestrained behavior, the toxin becomes more severe. Cases of Douzhen being deep,困 (trapped), critical, and desperate are not necessarily unrelated to parental causes. Just as children who are dwarfs or lame resemble their parents, how much more so the toxin of rashes and smallpox? Humans are born receiving the Qi of Heaven and Earth. When Heaven and Earth Qi change, Human Qi also changes. Encountering shifts in ruling Qi or loss of control, excessive victory and depression-rebound cycles, where virtues and commands deviate from norms, disasters repeatedly appear. Naturally, fierce Qi spreads contagiously, and syndromes are similar. Thus, mild cases are all mild, severe cases are all severe. If there is a controller, it is the work of epidemics. Therefore, those who die from leprosy/malignant diseases, their guides do not scatter, wandering souls come and go, following Qi, often transmitting this Qi to healthy people causing disease, similar to tuberculosis or leprosy contagion. However, those with robust constitutions and long blessings cannot be affected. In years of chaotic Yin and Yang, for those with weak bodies and thin fortunes, the solidity of the Gaohuang acupoints and the influence of Taitai spirits mutually infect, changing repeatedly. Techniques cannot restrain them, physicians cannot cure them. Is this not the harm of Gu Zhu? How should one treat these three types? Answer: One must preemptively resolve the toxin, calm the Qi, and move the location, so that avoidance might be possible. Commentary: The eruption of Douzhen clearly appears as seasonal epidemic Qi, spreading contagiously between cities and villages. Mild cases are all mild, severe cases are all severe. Except for one or two out of ten differing from the masses, how can one generally call it fetal toxin? Yet, those never infected by epidemics in their lifetime are common, whereas no one escapes Douzhen. After one infection with an epidemic, one cannot guarantee no re-infection, but after one outbreak of smallpox, there is no recurrence. Thus, can the theory of fetal toxin be entirely discarded? As for excessive fire and turbid blood, these existed in ancient times too, yet why was there no Douzhen affliction? To break the theory of fetal toxin is incorrect. There are many instances in the world of something non-existent suddenly appearing. Consider the flower named "Yu Meiren" (Beauty Yu). Yu Meiren was the favored concubine of King Xiang Yu. She died for him, and the world mourned her, composing songs. Leaning against the grass, singing sadly, the grass sways. Grass has no consciousness. When Chu did not exist, the concubine did not exist, let alone the grass? All sentient beings, through delusion and inversion, form the Three Realms. How could there be doubt about Douzhen?