Library

Zhuang Zaitian said: Regarding the disease of smallpox (Dou Zheng), smooth cases do not require treatment, and adverse cases cannot be treated; only dangerous cases (Xian Zheng) are treatable. If dangerous cases are treated with correct methods, the patient survives; if not, they die. Therefore, treatment methods must be precise. The *Neijing* (Inner Canon) does not mention this disease. Modern books circulating today all base their theories on the eight characters from the classic text: "All sores and ulcers with pain and itching belong to heat." Consequently, the initial approach emphasizes detoxification, and prescriptions invariably use cold and cool herbs, as this is what parents find acceptable. The concept of detoxification is most readily accepted, and the use of cold/cool properties seems logical. However, it is unknown that for smallpox, successful eruption is auspicious. Eruption relies entirely on the nourishment and cultivation of Qi and Blood to move from the interior to the exterior. The stages of even distribution of pustules (Qi Miao), filling with pus (Jiang Huang), and scabbing (Jie Jia) are all dominated by Yang Qi. Cold and cool herbs cause blood stasis and weaken robust Qi. When blood stagnates and Qi is broken, pathogenic toxins penetrate deeply into the deficiency. This is the origin of sinking and collapsing lesions in smallpox. It is like a pig bladder (Zhou Pao); if one wishes it to be inflated, it must be filled with air; if the air dissipates, it immediately collapses.

In such cases, symptoms include reduced appetite or poor digestion. Knowing that there is insufficient fire in the abdomen, during the eruption phase, it will be difficult to fill with pus or form scabs. This is due to insufficiency of Qi and Blood, which is named Deficient-Cold (Xu Han). One should quickly tonify Original Yang (Yuan Yang) to prevent complications. What constitutes Excess-Heat (Shi Re)? It refers to children with robust constitutions whose food digests easily. During eruption, their stools are dry and hard, urine is red and pungent, breath exhaled from the mouth and nose feels hot like fire, and they dislike heat while preferring coolness. This is named Excess-Heat. Only after carefully confirming internal heat can one temporarily employ clearing and resolving methods. Using Jingfang Dihuang Tang (Astragalus and Saposhnikovia Decoction with Rehmannia) with Shengdi Huang (Rehmanniae Radix) added with Da Huang (Rhei Radix et Rhizoma), the heat subsides after one or two doses. However, one must not mistake Deficient-Fire (Xu Huo) for Excess-Fire. The method to distinguish between Deficient-Fire and Excess-Fire relies primarily on urination and defecation. If urine is clear and white, and stools are not dry, despite high fever, this indicates Cold in the Middle Palace (Zhong Gong, referring to the Spleen and Stomach). The Fire has no foundation and floats outward. Misusing cold/cool herbs can also produce these symptoms. One must not assume Excess-Fire simply because of body heat. Deficient-Fire accounts for eight or nine out of ten cases, while Excess-Fire accounts for only one or two out of ten.