Child’s Smallpox Trapped Under the Skin for Three Days — Doctor Wu Jutong Pulls a Six-Year-Old Boy Back from the Brink
Patient search terms: child smallpox / smallpox / pox rash / pox not coming out / dry shrunken pustules / pox stuck together in patches / child with pox for three days Medical terms: smallpox (tian hua) · pox rash (dou zhen) · severe dangerous pox (zhong xian dou) · pox poison turning inward (blood stasis with toxin knotting)
The opening: smallpox has been eradicated — so why are we still talking about it?
Doctor Wu Jutong, the great physician of the Qing dynasty, was a remarkable warm-pathogen (wen bing) specialist. Among the stories of his practice, cases of smallpox are especially numerous — because in those days, countless children came down with the pox. Only after immunization against smallpox became widespread was the disease finally wiped out from the whole world. Today’s case: how he treated a six-year-old boy with smallpox.
💬 Note from Doctor Luo: Some friends ask: smallpox has been eradicated — so why still talk about it? First, there is a principle of Chinese medicine in it worth learning. Second — pox-type diseases: who knows, in this world of ours, when something like this may surface again? Just look at the news: monkeypox is spreading around the globe. So these ideas really must not be taken lightly; this is worth studying.
December 1803: six-year-old Xu Zhongxian, three days into smallpox, already failing
On the fourth day of the twelfth lunar month of the gui-hai year (1803, the 8th year of the Jiaqing reign), a six-year-old boy came for treatment. His surname was Xu, his given name Zhongxian. The pox had already been out for three days — and after only three days it was already a heavy, dangerous case; Doctor Wu wrote the two characters “zhong xian” (heavy and dangerous) on his record, which tells you how serious it was. This boy was plainly one of those weak-bodied children: skin and bone, no flesh on him — standing there, his blood withered and dry; he simply did not have much blood.
Now look at the pox itself: dry, dark red, stuck together in patches, every one of them hidden beneath the skin — flat, unable to come out.
💬 Note from Doctor Luo: With pox, what you want to see is pustules rising bright, shiny and plump. When they are dry, stuck together in patches and hidden in the skin, unable to erupt — that is a big problem. The blood is dried up, the blood is stasis-bound, and the poison is all bottled up inside. How could the pustules ever swell up?
Doctor Wu takes one look: far too severe — the usual approach may not reach it
Doctor Wu said the illness was too heavy — “barely pardonable even under heavy penalty” — in other words: this is a critical situation. If one set a formula by the usual line of treatment, the whip would be too short to reach — it might not pull the boy through. So he opened a very heavy prescription.
The first formula: four liang of rhubarb leads the charge — half raw, half blackened in yellow wine
First herb: zi hua di ding (violet yam root), one liang. Di ding is the standard herb for sores and toxic swellings — it resolves toxin, and one liang is already a heavy dose. Then da huang (rhubarb): half raw, half fried black in yellow wine — four liang in all. The raw half descends: it goes straight to the lower burner, enters the intestines, and drains the heat-toxin out. The other half, fried black in yellow wine, sends the rhubarb’s action up to the upper burner and out to the limbs — traveling through the whole body to resolve toxin.
💬 Note from Doctor Luo: One liang of rhubarb is 30 grams; four liang is 120 grams — an extremely formidable dose! The ancients said “you gu wu yun” — when the poison is severe, the medicine must be severe. Rhubarb naturally moves downward; fried in yellow wine, it can move upward and out to the limbs, clearing the heat-toxin away.
Then hawthorn flesh, half raw and half fried, three liang: the raw part breaks up stasis; the fried part transforms the stagnant accumulation inside and digests food stagnation. Siam rhinoceros horn (xi luo xi jiao), one liang — Siam is today’s Southeast Asia; rhino horn penetrates heat. And peach kernel (tao ren), half raw half fried, four liang: raw peach kernel is excellent at activating blood and dissolving stasis; fried, it moistens dryness and moves blood — where dryness in the intestines is the problem, it moistens the bowel and works with the rhubarb to carry things downward.
Honeysuckle (jin yin hua), two liang, clears heat and resolves toxin; safflower (hong hua), three qian, activates blood and dissolves stasis — the blood is stasis-bound there, which is exactly why the pox cannot push through; green tangerine peel (qing pi), two liang, breaks and regulates qi — when heat-toxin is fierce there is stasis and stagnation, and qing pi regulates the qi.
The strangest guide ingredient of all: pig-tail blood with borneol
The prescription was done — but with it came a guide ingredient nobody had ever seen: pig-tail blood, half a small wine cup each time, with shang mei pian (natural borneol), three pellets, ground fine and stirred into the decoction.
💬 Note from Doctor Luo: A pig’s tail is always in motion — lively, frisky — and the ancients believed pig-tail blood is exceptionally powerful at dissolving stasis. In the old days, when a new mother’s lochia would not stop, pig-tail blood was used to resolve it. Nobody drinks it now; the pig-tail blood you draw today comes out black. What is the most malignant sign in smallpox? When the pustule is an empty shell outside with no blood color at all — the blood is all stasis-bound inside, stuck together with the poison, unable to erupt outward. The proper course is for the pustules to fill up, dry, and form scabs. Stasis inside simply will not do. As for shang mei pian: it is natural borneol extracted from borneol camphor (long nao xiang), with a color like plum blossom; it opens the channels — with one dose the channels open right through. Today’s borneol is almost all synthetic.
How to take it: eight bowls of water boiled down to three — and half a bowl again around 11 p.m.
How was this medicine taken? Eight bowls of water, boiled down to three bowls. First take half a bowl; then, around 11 p.m. (the hour of zi), take another half bowl. The measure of success: the tongue coating recedes and the pox begins to rise. Originally the tongue coating should have been thick, greasy and yellow. When the coating retreats and the pustules swell up, the medicine is working.
The next day, the fifth: the pox really did start coming out!
The next day (the fifth), the pox had been out four days, and the “heavy and dangerous” verdict still stood. But after that massive dose of rhubarb, the pox began to erupt! Since it was erupting, there was no more need for descending, sinking herbs — Doctor Wu switched to cooling the blood and lifting — lifting the “price” inside (the upright qi, the pox pus) upward.
💬 Note from Doctor Luo: At this point he used jin yin hua (honeysuckle) to clear heat and resolve toxin; wu xi jiao (rhinoceros horn) eight qian; and ling yang jiao (antelope horn), five qian — antelope horn also penetrates heat, clearing liver-gallbladder heat, and treats blood-heat in warm-pathogen disease: warm-toxin rashes, carbuncles and furuncles, high fever, liver wind stirring internally, and infantile fright seizures with arched-back rigidity — all use it. Forsythia (lian qiao) clears heat and resolves toxin; zi hua di ding five qian — and with it ren zhong huang, three qian — this herb deserves a proper explanation.
Ren zhong huang: the “dirty herb” fermented in a cesspit — actually a treasure for treating pestilence
Ren zhong huang — the name sounds connected to feces. Some people laugh as soon as they hear it: “Chinese medicine even uses excrement?” It really is not what it sounds like. This herb needs a proper explanation.
💬 Note from Doctor Luo: How is it made? Take a bamboo tube and cut an opening; put licorice powder inside, then place bamboo shavings (zhu ru — the white silk inside bamboo) in between as a separator, and seal the opening tightly with pine resin — airtight inside, so only the bamboo fiber lets certain substances pass through. Then the tube goes into a cesspit, where it stays — generally for a whole winter. This is a fermentation process, closely related to what we now call the gut microbiota. But I believe what accumulates in there is deeper than that — more than just microbiota. When it comes out, the tube is placed in a clear river, in the flowing water, for 49 days (seven sevens — nowadays two or three weeks is probably enough); then it is opened and set in the sun by day and exposed to the dew at night — called ri shai ye lu, “sun by day, dew by night.” After all this, the thing has virtually no smell — and only then is it ren zhong huang. So it is not feces itself at all: only the odor has penetrated in, transforming the licorice into a medicine that clears heat, resolves toxin and treats pestilence specifically. Its detoxifying power is exceptional. In the old days, when treating pestilence — the severe epidemics where people burned with heat, broke out in rashes and raved nonsense — ren zhong huang was commonly used. A medicine that has survived thousands of years must work; exactly what change takes place inside remains a mystery — modern science cannot explain it yet.
The formula also included bai zhi (angelica root), two qian (to disperse outward); ku jie geng (platycodon), five qian (to open and lift the lung qi — the herb’s action moves upward); bai mao gen (cogongrass root), one liang (Doctor Wu believed its heat-clearing and toxin-resolving power was especially good — for any toxic heat, bai mao gen can take it down); and zao zhen, two qian — that is the spine of the soap-bean tree (zao jiao ci): it resolves toxin and has a penetrating, erupting quality — when a sore is not yet ripe and will not break, zao zhen is added to push it out.
The sixth and seventh: great improvement — but the fire-toxin is still too heavy to touch tonics
On the sixth, the pox’s fifth day, Doctor Wu had already treated him for three days — great improvement! The method shifted to cooling the blood, activating the blood and defeating toxin: cooling and activating the blood to break up the heat-toxin stuck together — defeating the toxin on one side, cooling and activating the blood on the other. Honeysuckle eight qian; rhinoceros horn and raw rehmannia (cooling the blood while scattering and penetrating the pathogen); zi hua di ding five qian; forsythia four qian; ku jie geng five qian; ren zhong huang two qian; rhinoceros horn five qian; antelope horn five qian; bai mao gen one liang; bai zhi three qian — taken in four divided doses.
On the seventh, the pox’s sixth day, the pus was about to fill — but the fire-toxin was still too heavy. At this point — one thing: no tonics. No supplementing herbs. Still cool the blood and resolve toxin, to prepare the ground for scabbing. Newly added to the formula: xuan shen (figwort root), five qian.
💬 Note from Doctor Luo: Yuan shen is xuan shen — in the Qing dynasty it was always written yuan shen. Xuan shen’s toxin-resolving power is formidable — a single herb of xuan shen can clear heat-toxin on the skin from the whole body.
The eighth through the tenth: cut the rhino horn, add ophiopogon — the pus fills and the scabs begin
On the eighth, the pox’s seventh day, the previous formula cut the rhinoceros horn in half and added mai dong (ophiopogon), five qian, to nourish yin and moisten dryness. On the ninth — the eighth day — the pus was fully satisfied: the pustules were completely full, their color turning grayish, and the stomach qi was strong again. Now the approach was cool-and-spicy herbs to help the scabbing — clearing heat and resolving toxin as the main job, and the fiercest herbs began to be withdrawn: honeysuckle three qian; bai mao gen five qian; mai dong with the heart retained, five qian (strengthening the heat-clearing); forsythia three qian — and added wu gu chong, one qian five fen, and licorice one qian five fen.
💬 Note from Doctor Luo: What is wu gu chong? It is the larva of a fly — a maggot — cleaned, dried and used as medicine. The ancients worked out uses for everything: wu gu chong can dissolve gan ji — the “sweet accumulation” malnutrition of children: when a child’s food stagnation has gone on long enough, the belly swells up big and drum-like while the four limbs are thin as hemp stalks, and nothing they eat ever puts weight on them — that is gan ji, and wu gu chong can transform it. It also penetrates heat, resolves toxin and clears heat. This boy was plainly having digestive trouble — remember how he was skin and bone, a bag of bones? His spleen-stomach must have been at fault. Everything born of nature has its own medicinal nature, its own bias — and the ancients used those biases to regulate the body. Don’t go gathering this herb yourself; get it from a proper pharmacy.
On the tenth, the limbs were still hot — herbs of strong cool nature were needed: honeysuckle, western raw rehmannia, yuan shen, forsythia, bai mao gen, tree peony bark (dan pi), mai dong, raw licorice, scutellaria (huang qin) and yellow-wine-processed rhubarb — only when the heat is thoroughly drained can the body begin to recover.
The eleventh through the fourteenth: supplement the spleen, support the upright — complete recovery
On the eleventh, the pus was returning very slowly, with a slight cough — amid the cool-and-spicy treatment, a little spleen-supporting medicine was added: ginseng (ren shen), western raw rehmannia, forsythia, tree peony bark (dan pi, draining the liver), raw coix seed (yi ren, strengthening the spleen), mai dong, ren zhong huang, di gu pi (wolfberry root bark), huang qin, bai mao gen and winter mulberry leaf (dong sang ye). The twelfth and thirteenth continued the same formula. On the fourteenth — fifteen days into the illness — complete recovery! The scabs had begun to form; once the scabs fall off, the disease is over — only a little residual toxin remained.
The closing formula: xian ren zhang pi — that is di gu pi, wolfberry root bark (clears heat); forsythia; wu gu chong two qian; ren zhong huang one qian five fen; tree peony bark three qian; bai mao gen three qian — clearing the residual toxin completely, and the case was closed.
A professional’s eye: how a critical case is peeled back, layer by layer
A child in the most critical danger from smallpox, with severely deficient upright qi — Doctor Wu treated him for over ten days, adjusting the formula every single day. How did he peel it back, layer by layer?
💬 Note from Doctor Luo: First, extraordinary means — heavy purging and heat-clearing, in very large doses (the rhubarb went all the way up to four liang!). Once the overall situation was under control, he began gently clearing heat and resolving toxin, pushing the pathogen outward. Then, gradually, spleen-supplementing herbs were added to support a little upright qi — and the child slowly recovered. A professional sees the method; a layman sees only the spectacle — serious illness is peeled back exactly like this, layer by layer. And there is a piece of Chinese-medicine culture hidden here: in treating pestilence, ancient physicians would sometimes use extraordinary medicines — ren zhong huang is the representative. Modern science can only say it is a fermentation process related to the gut microbiota — but I believe that is only a small part of it. Sadly, ren zhong huang has taken a beating in reputation — “too dirty, soaked in a cesspit.” Cesspits are hard to find these days, and the herb is basically unused — yet in ancient times, in treating critical infectious epidemics, it was used constantly.
Compiled from Doctor Luo Dalun’s commentary on the medical cases of Wu Jutong; the case is from the Wu Jutong Yi An (The Medical Cases of Wu Jutong).