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My nephew Sun Wangxuan, aged six, had always been constitutionally weak. Occasionally, upon contracting cold or consuming cold foods, he would develop wheezing, diarrhea, and fever. It was well known that his middle jiao deficiency generated internal cold, making warming and tonification appropriate, while cold-cooling herbs were contraindicated. In the year Jiayin of the Qianlong reign (1734), when he suffered from smallpox, the physician prescribed herbs such as Shengdi Huang (Rehmanniae Radix) and Yinhua (Lonicerae Japonicae Flos). I stated, "The properties of these medicines contradict his constitution; how can they be symptomatic?" Therefore, I changed to Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex). After four doses, the smallpox pustules crusted over, and he recovered.

A child surnamed Jiang, aged two, had a fever for three days, and his smallpox had fully erupted but was not very numerous. The smallpox specialist intended to administer Dahuang (Rhei Radix et Rhizoma) and Lianqiao (Forsythiae Fructus) via gavage. I said, "If these drugs are administered, causing one or two episodes of diarrhea, the smallpox will retract." They did not believe me; indeed, after the diarrhea occurred, the smallpox did retract. The specialist then fed him water boiled from a young pigeon. The next day, many small pustules suddenly erupted. I said, "It is evident that tonification should be used." However, the smallpox doctor still administered only a few granules of minor medicine, leading to incessant diarrhea and death.

A maid named Xilian, aged five, had a fever for one day, with red spots covering her body in patches. The smallpox doctor said, "This is called 'Fire-Scorched Seedlings,' a fatal condition on the twelfth day; there is no chance of survival, so medication is unnecessary." I feigned agreement but prescribed Dabu Yuanyuan Jian (Great Tonification of the Original Source Decoction) for two doses. Her spleen and stomach function improved slightly. After four more doses, the seedlings were full and filled with fluid, though their color was dull and they did not crust. After seven additional doses, they crusted; after ten doses, she fully recovered. The doctor remarked, "Such successful eruption must never be underestimated."

My paternal nephew Wenbao, aged one, suffered from measles without timely dispersal. Repeated use of cold-cooling herbs led to diarrhea, vomiting, cracked lips, and a black tongue, progressing to slow convulsions, with life hanging by a thread. Upon examination, I told the attending physician, "This is due to cold herbs forcing deficient fire upward. Although the exterior appears extremely hot, the interior is truly cold." The physician argued, "Cracked lips and a black tongue—could this not be excess heat?" I replied, "Diarrhea with clear stools—could this not be deficiency cold? Is there any case of excess heat accompanied by diarrhea and clear urine?" The physician could not answer.

Case Record: The son of Magistrate Wei, aged three, had sparse smallpox. The specialist used several doses of cooling herbs. Fortunately, the child's constitution was strong; although severe diarrhea did not occur, the dark spots did not fade, indicating that the true fire had been cleared. Over a month post-smallpox, a boil suddenly appeared on the vertex, unchanged in skin color, large as a wine cup, caused by the stagnation of cold herbs. I used Dawenzhong Yin (Great Warming of the Middle Decoction), which resolved it after several doses.

Shu You’s son, aged ten, had his entire head ulcerated, oozing pus and bloody fluid from dozens of lesions. His father stated, "This is smallpox toxin, unresolved for half a year." Reviewing past prescriptions revealed frequent use of Lianqiao and Shengdi Huang. It became clear that cold herbs entered the stomach, leaving fire without a foundation, rushing upward to the head—this is what is termed "Deficient Yang Piercing the Vertex." The method of guiding fire back to its source was appropriate. Using Dabu Yuanyuan Jian combined with dispersing herbs, one dose daily, resulted in complete recovery within ten days.

My paternal nephew, aged seven, developed sparse smallpox in Changzhou. The physician used cold herbs to resolve toxicity. Although the lesions did not collapse initially, their appearance was already disordered. One month later, a large carbuncle appeared on the right leg with unchanged skin color. The physician insisted it was fire toxin and continued treating with Shengdi Huang, Yinhua, Huangqin (Scutellariae Radix), Shanzha (Crataegi Fructus), and Zhizi (Gardeniae Fructus). After one dose, spleen and stomach function worsened, and spirit became lethargic; after two doses, vomiting and diarrhea ensued; after three doses, everything taken was immediately vomited. The quack physician, unaware that the medicine did not match the syndrome and thus was rejected by the stomach, claimed, "The medicine is vomited but not the taste, causing the lesion color to become dull," and the child died a few days later without suppuration.

A monk from Lu'an, elegant and poetic, developed fever and smallpox in his twenties. Upon examination, I noted sparse particles with vibrant roots. He reported normal appetite and bowel/bladder functions. When he requested medication, I said, "With such favorable smallpox presentation, no medication is needed." The next day, another specialist visited and administered various cooling herbs to purge fire, adding Sanqian (three qian) of Dahuang per dose. After three consecutive doses, incessant diarrhea occurred, the smallpox collapsed, he refused food, and died within days. For individuals with weakness developing smallpox, mistakenly administering Dahuang is truly poisonous. This has been verified through practice, and I dare not conceal it. Practitioners treating smallpox must reflect deeply.

My grandson Wang Ling, in the fifth month of the Bingchen year, was under one year old. He historically had loose stools and soft waist, indicating insufficient qi and blood. Suddenly, after one day of fever, dense smallpox erupted all over his body. Each pustule had a small pore leaking yellow fluid. His eyes remained open, unable to close temporarily, and he suffered diarrhea more than ten times a day. Milk entered his mouth but flowed out from the lower orifice; his anus lacked margins, appearing as a hollow hole. The *Dou Shu* (Book on Smallpox) states: "An anus like a bamboo tube is incurable." Physicians stood by helplessly. I stated, "This is the syndrome of heavy yin toxicity and massive yang deficiency described earlier in the fever discussion. Without significant warming and tonification, survival is impossible." I prepared Dabu Yuanyuan Jian, using Fuzi (Aconiti Lateralis Radix Praeparata) 2 qian, Rougui 3 qian, Paojiang (Zingiberis Rhizoma Preparatum) 1.5 qian, Dingxiang (Caryophylli Flos) powder 0.5 fen, and Hujiao (Piperis Longi Fructus) powder 0.3 fen per dose. Boiled thickly and filtered, it was frequently administered day and night. The liquid exited through the lower orifice immediately upon entry. Despite nine attempts exhausting one dose, observers said, "No need to continue; just wait for time." Fortunately, his mother observed carefully, noting, "Although the medicine flows out, less seems to remain, and after each administration, his eyes close briefly. This must be effective." Thus, the original formula was unchanged, administered once daily as before. After three more doses, the child managed brief sleep. The stool turned green-black with yellow traces, indicating the revival of stomach qi. Following the same formula for three more doses, the anus regained margins, diarrhea slowed, the pores on the pustules filled, and they began to rise, filling with clear fluid. Adding Gulong (Ossis Ferreum Preparatum) powder and Susuqiao (Papaveris Pericarpium) 1 qian each to the original formula, four more doses were given. The smallpox fully crusted. By the thirteenth day, all crusts fell off, spots vanished completely, and the abdomen healed. Those who heard this marveled. I recognized this child’s condition as deficiency-cold; the appropriate medication yielded results. Ordinary diarrhea cases can also be treated similarly. The above is recorded in *Suniu Bian*.