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Smallpox (Dòuzhěn) is the Yin toxin (Yīn dú) formed in the fetus, which must rely on Yang Qi (Yáng qì) to mature. Children with smallpox typically experience fever for about three days; once the muscles become loose and permeable, the pustules (dòu diǎn) appear uniformly. When the fever subsides, it indicates that True Yang (Zhēn yáng) is hidden internally and interacting with Yin. Fever recurs for another three days, representing the transport of fluids to the pustules to form clear serum (qīng jiāng). Once the serum is sufficient, the fever subsides. During the stage of nourishing the serum (yǎng jiāng), True Yang emerges externally, causing fever for three more days to transform toxins into pus (nóng). After the pus forms, the fever subsides again as Yang becomes hidden. Since the toxin has turned to pus, further fever is required to evaporate the moisture before scabs can form. After the scabs fall off, True Yang emerges externally to evaporate and resolve the spots, a process called "burning spots" (shāo bān). If black spots appear, it signifies Fire deficiency (huǒ shuāi), not due to consuming salt or soy sauce. This illustrates that smallpox originates from Yin but matures through Yang. Therefore, the treatment principle for smallpox should always prioritize tonifying Qi and Blood (qì xuè) and supporting Yang Qi. Medication should primarily use warming and tonifying herbs, with a minor addition of dispersing agents. Otherwise, insufficient Qi will prevent the pustule tops from rising, and insufficient Fire will result in thin serum, potentially leading to cold limbs (jué nì), abdominal pain, and the onset of severe complications due to rising Yin Cold.

A question arises: It is clear that smallpox requires warming and tonification; if dispersing agents are added, will they not damage Qi? The answer is that purely using dispersing herbs causes excessive sweating, which damages Qi. However, adding a small amount of dispersing herbs to warming and tonifying formulas unblocks the blood vessels, facilitates the eruption of smallpox, prevents stagnation, and allows the body to benefit from the dispersal of pathogens. Thus, ancient formulas like Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) contain Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), and Dawenzhong Yin (Greatly Warm the Middle Decoction) contains Mahuang (Ephedrae Herba). Even when warming and tonifying Qi, dispersing herbs are used, demonstrating the profound wisdom of ancient physicians. At the initial stage of smallpox eruption, dispersing herbs must absolutely not be omitted.

Another question: It is now clear that smallpox treatment involves warming, tonifying, and dispersing. However, the later formulas Dabu Yuanyuan Jian (Greatly Tonify the Origin Decoction) and Liuwei Huiyang Yin (Six-Ingredient Return Yang Decoction) heavily use Fuzi (Aconiti Lateralis Radix Praeparata) and Rougui (Cinnamomi Cortex), without any dispersing herbs, and instead include astringents like Longgu (Fossilia Ossis Mastodi) and Suke (Papaveris Pericarpium). What is the rationale? Warming, tonifying, and dispersing is the method for ordinary smallpox cases. In some children, fever lasts only one or two days before the body erupts with smallpox. Ancient texts lack prescriptions for this, and contemporary doctors are at a loss. This condition results from severe Yin toxicity and extreme Yang deficiency. When the Yin toxicity erupts, the Yang Qi is already exhausted, leading to incessant diarrhea and dysentery. The excrement is often dark green or black, indicating transformation by Liver Qi and the impending exhaustion of Stomach Qi. In such urgent cases, Dabu Yuanyuan Jian and Liuwei Huiyang Yin should be administered in large doses continuously. These formulas support Yuan Yang (Primordial Yang) and clear Yin toxicity, achieving the miraculous effect of restoring life from death. When decocted together, they are named Fanshun Dan (Return Soul Pill), which has yielded numerous successful cases in treating smallpox. Readers should carefully study my medical case record of treating my nephew Wang Ling.

Regarding cooling herbs for clearing fire and detoxifying, they may only be used temporarily after confirming the presence of Excess Fire (Shí huǒ). If mistakenly used when the pustules are uniform, fluids cannot ascend, causing the pustule tops to sink. If mistakenly used during the serum-nourishing stage, the serum will fail to thicken, leading to itching and collapse, which clearly indicates True Fire deficiency. In such cases, immediately administer Renshen (Ginseng Radix) and Shudihuang (Rehmanniae Radix Praeparata), decocted with Fuzi and Rougui, to simultaneously tonify the Spleen and Kidney. Large doses administered continuously can still reverse the situation. Otherwise, chills, teeth grinding, vomiting, and diarrhea will occur, rendering the condition incurable. Conditions such as cool body temperature with non-drying pus, spots failing to resolve after scab detachment, and post-smallpox toxicity are all caused by the mistaken use of cooling herbs like Shengdi Huang (Rehmanniae Radix), Jinyinhua (Lonicerae Japonicae Flos), Zexie (Alismatis Rhizoma), and Lianqiao (Forsythiae Fructus). One must understand this. Heat is categorized as either Pathogenic Heat (Xié rè) or Physiological Heat (Zhèng rè), requiring careful differentiation. Physiological heat is the steaming of Yang Qi from inside out; the pustules emerge without aversion to cold, the fever comes and goes, accompanied by slight sweating, warm hands and feet, normal appetite, and regular urination and defecation. This indicates no pathogenic factors inside or outside, and no medication is needed. Pathogenic heat results from accidental exposure to Wind-Cold, presenting with headache, aversion to cold, cold limbs, and anhidrosis. Adding Qian jin (5 grams) of Rougui to Jingfang Dihuang Tang (Schizonepeta, Saposhnikovia, and Rehmannia Decoction) can resolve the exterior pathogen within one or two doses. As the ancients said, "Heat should not be completely eradicated," which is indeed a true maxim.