Library

The recovery of smallpox (痘疮) relies entirely on Qi and Blood. The principles governing the fullness or deficiency, growth or decline of Qi and Blood are subtle and must be thoroughly understood. Generally speaking, Qi is Yang in nature, light and clear, tending to ascend; Blood is Yin in nature, heavy and turbid, tending to descend. When the rash erupts, the pustules at the higher positions represent the domain of Qi, located superiorly, where Qi should exert its influence. The erythematous halo and base surrounding the lesions represent the domain of Blood, located inferiorly, where Blood should adhere. If the apex is pointed and the color is white and moist, it indicates that Qi is respected and resides in its appropriate ascending position. If the periphery has a halo and the color is red and vibrant, it indicates that Blood adheres and remains secure in its appropriate descending position. When Qi occupies its respected position and Blood stays within its proper bounds, Qi and Blood harmonize and smoothly transport the pathogenic toxins outward. This is the most auspicious presentation, which may heal spontaneously without medication. If the apex is depressed and Qi sinks instead of ascending, this indicates Qi deficiency failing to fill and support; the treatment method should be to tonify Qi. If there is no red halo around the base, this indicates Blood deficiency failing to adhere; the treatment method should be to nourish Blood. This principle is particularly easy to understand. However, if the entire lesion turns red forming blood blisters, it indicates Blood abnormally ascending. This condition is extremely dangerous; pus formation will inevitably fail. By the eighth or ninth day, the patient will die from itching and collapse. Yet, this is not merely due to Blood excess, but rather because Qi deficiency causes the loss of its normal role as the ruler, allowing Blood to act recklessly and manifest redness. If one mistakenly diagnoses this as Blood Heat and uses formulas to cool Blood and invigorate Blood circulation, it will further deplete Qi and accelerate death, which is truly tragic! Therefore, the principles of Qi and Blood fullness and deficiency are subtle and difficult to discern. Regarding the regulation of Qi and Blood: if only Qi is deficient, one should exclusively tonify Qi and avoid nourishing Blood, because Yang cannot follow Yin; if Yin grows excessively, Yang declines. If Blood is deficient, it is often caused by damage to Stomach Qi and insufficiency of Yuan Qi (Primary Qi). In such cases, nourishing Blood should be combined with tonifying Qi, because Yin follows Yang; when Yang generates, Yin grows. Huang Ruyan, in *Ming Yi Za Zhuo* (Miscellaneous Writings of Famous Physicians), claimed that using Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root) to tonify Qi in cases of Blood deficiency would cause Yang to flourish and Yin/Blood to decline further. This is profoundly erroneous! His failure to understand the principles of Yin-Yang growth and decline led to harmful advice for the world. Whenever I treat postpartum women with high fever due to excessive blood loss, women with Blood deficiency suffering from metrorrhagia (崩漏) with continuous bleeding, or those with hematochezia (便血) leading to defecation incontinence due to deficiency, I use Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Gan Jiang (Dried Ginger), and Fu Zi (Prepared Aconite Root), assisted by Blood-nourishing herbs and lifting agents. All achieve remarkable effects. How can one claim that Qi should not be tonified in Blood deficiency? For pediatric smallpox, which relies primarily on Stomach Qi, nourishing Blood must begin with tonifying Qi. Thus, the principles of Qi and Blood growth and decline must be deeply understood.