典藏书目

The method for treating smallpox (or chickenpox/variolous diseases) emphasizes caution at the beginning and consideration of the final outcome, so as to avoid future regrets. The Classics state: A superior physician treats disease before it arises; an average physician treats it when it is about to arise; an inferior physician treats it after it has arisen. Treating before onset yields eight or nine successes out of ten; treating when impending yields four or five successes out of ten; treating after onset renders medical intervention largely ineffective.

At the initial stage of fever, if symptoms such as high fever, thirst with irritability, constipation, abdominal and lower back pain, dry nose and lips, palpitations, and delirium appear, this indicates toxic qi stagnating and obstructing internally. At this point, one must prevent the pathogen from remaining latent and failing to erupt. If vomiting and diarrhea persist, one must guard against deficiency of middle-jiao qi, which fails to assist in maturing the lesions, potentially leading to involution (inward collapse). Therefore, heat should be resolved, constipation should be purged, fright should be pacified, and vomiting/diarrhea should be stopped.

Consider the initial eruption: a single blood-colored spot corresponds to the spring qi of generation, the command of sprouting. The subsequent rising and expansion correspond to the summer qi of growth, the command of nourishing. The transformation of fluid into pus corresponds to the autumn qi of solidification, the command of ripening. The drying of pus and scabbing corresponds to the winter qi of storage, the command of conservation.

If water blisters appear immediately upon eruption, or if they are filled with fluid during the rising phase, or if scabs form before pus is fully generated, this is termed "arriving before its time," known as excess. This inevitably leads to involution and latent pathology. Methods of releasing the exterior, supporting the interior, and detoxifying must not be delayed. Conversely, if eruptions fail to appear, rise, or resolve as expected, this is termed "arriving late," known as insufficiency. This is invariably due to deficient qi and weak blood. Methods of harmonizing qi, activating blood, and detoxifying must be applied urgently.

Furthermore, if early lesions are bright red and the skin is tender, the tenderness makes them prone to rupture; one must guard against pruritus-induced collapse. Clustering into masses does not indicate sparseness but suggests latent pathogens. Empty shells without fluid will later develop abscesses. Pre-existing swelling of the face and head requires guarding against easy resolution and inward collapse. Sore throat requires urgent relief to prevent loss of voice or choking. Numerous vesicles in the center predict subsequent diarrhea. Dry eyes with tearing warn of corneal opacity (leukoma). Frequent bowel movements warn of premature scab shedding (involution); broken lesions that do not scab constitute involution.

Yaofu said: "It is better to prevent illness beforehand than to take medicine after falling ill." This is precisely what he meant.

The *Zhinan* states: Qi manifests as white, blood as red. When the toxin first erupts, blood and qi are unsettled, and auspicious/inauspicious signs are indistinct. The distinction between red and white forms is not yet clear, appearing only as a faint red spot on the cheeks, ears, nose, and nasolabial folds. Subsequently, a slight whiteness appears within, while the exterior remains faintly red; here, fortune and misfortune are already determined. Later, the base becomes diffuse, the central whiteness enlarges, and the peripheral faint redness thins; here, the mechanism of auspiciousness, inauspiciousness, regret, and caution becomes evident. As the lesions become sharp, round, and lustrous, the central whiteness fills out, and the peripheral red halo thins. At this stage, the intention to generate pus begins; the central whiteness takes on a slight yellow hue while remaining vibrant and red.

After five to six days, although the internal whiteness may turn yellow, it remains within the realm of red and white; the external red circle thins but is not yet minute. By the sixth or seventh day, the central whiteness turns pure yellow, though not yet mature; the external red halo is merely a thin line of ruddy luster. By the eighth or ninth day, the lesions mature into pus, becoming round, clean, and plump, yellow in color without a red halo. Here, the sequence of qi and blood is orderly, and treatment achieves success. By the eleventh or twelfth day, gradual drying and yellowing occur, sometimes resembling greenish lesions, indicating the restoration of qi and blood. Nevertheless, the risk of involution persists and cannot be ignored. By the twelfth or thirteenth day, the dried yellow skin wrinkles and forms old scabs. Progression from head/face to hands/feet is favorable (shun); progression from hands/feet to head/face is unfavorable (ni). By the thirteenth or fourteenth day, the old scabs fall off.

However, complications may arise even after scabbing. Some suffer from "lacquer-faced flesh-piercing" (persistent inflammation), fever, red eyes and face, irritability, and thirst. Others present with facial edema, eye swelling, and nausea. After scab shedding, ulceration may occur at the site. Persistent fever, oral ulcers (gan), and white tongue coating may appear. Toxicity may manifest in the limbs, or carbuncles/furuncles may develop. White obstructions may form in the eyes, or the sclera may become exposed. Although the rash has subsided, myriad disasters may ensue; how can one neglect prevention simply because scabs have fallen?

If scabs shed cleanly and smoothly, the treatment seems successful. Yet, it is not over. Some develop white scars after shedding; others experience lingering fever and chills for months. Complications such as flowing abscesses (liuzhu), skin sores/scabies, thirst, mania, irritability, panting, and restlessness may still occur. Even after scabs fall, residual symptoms persist, and life or death remains uncertain. Can those treating these diseases consider scab shedding as a sign of safety!