Newlywed Boy Gets Smallpox, Rash Turns Blue, and He Talks Nonsense?
Searched by patients: newlywed breaking out with smallpox / smallpox / getting the pox / bluish pox rash / shivering and talking nonsense / vomiting after smallpox / constipation for over a year Medical terms for this case: smallpox · pox rash · pox toxin sinking inward (heat toxin entering the blood level) · residual yangming heat · qi and yin deficiency
The opening: monkeypox is here — let’s see how the ancients fought pox diseases
Everyone knows by now that monkeypox has started spreading and cases have appeared. In June, more than one hundred cases were reported nationwide, and the growth is fast — last month there were very few; this month the number jumped from the tens to over one hundred. Korea took half a year to reach that number; we did it in one month. So it’s genuinely worth learning a little about pox-type diseases.
💬 Note from Doctor Luo: The ancients actually fought this kind of disease for many years — what the ancients called smallpox (tian hua) is very similar to monkeypox. The case we’re telling today is a real record of how an ancient doctor treated smallpox. Smallpox was ferocious in history: when the Qing dynasty emperors chose their successors, those who had survived smallpox were preferred — why? Someone who’d never had it might come down with it someday and die; someone who’d survived it had immunity and was safe. So you can see how seriously the ancients took fighting smallpox.
A 16-year-old groom breaks out with the pox
The hero of this story is Zhang Yuhan’s second son, 16 years old that year. People married young in ancient times, so at 16 he got married. For the wedding, the family feasted relatives and friends — plenty of good food and drink, and wine without question. And right at this moment, he was suddenly infected with smallpox and broke out.
That was quite dangerous in those days. The doctors who came all thought it untreatable — the circumstances were too bad.
💬 Note from Doctor Luo: By the way, “ci lang” is not a name — Zhang Yuhan’s ci lang simply means his second son. Later the Japanese adopted “jiro” for naming their sons, still following the Chinese practice. At the time there was a doctor named Shi Jiquan, a very close friend of Doctor Miao Xiyong and a famous pox specialist, who recorded his experience in his book: when pox breaks out after marriage, if the patient has back pain, it can still be treated; but if an unmarried boy has back pain, that is congenital kidney-water deficiency, and he considered it untreatable. This young Master Zhang had just married and overindulged in food and wine — exactly the most worrying situation.
Day eight: the rash turns blue, and he shivers, clenches his teeth, and talks nonsense
Doctor Shi Jiquan arrived. He was the famous pox doctor who appears again and again in these cases — many of the case records are his. He lived in Liangzhu, twenty-five li from Tangxi in Hangzhou.
By the eighth day of the pox, the situation turned sharply for the worse: the rash turned blue, and the boy began shivering with clenched teeth — chattering his teeth through the chills, then trembling and talking nonsense, his mind clouded and confused. His body’s reaction was enormous.
💬 Note from Doctor Luo: At this point the other physicians all said this was deficiency and wanted to tonify heavily with Bao Yuan Tang (Source-Protecting Decoction) — huang qi (astragalus), ren shen (ginseng), gan cao (licorice), and rou gui (cinnamon) — pushing hard to build the patient up. But Doctor Shi Jiquan disagreed and switched to Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction): xi jiao (rhinoceros horn) cools the blood, matched with sheng di huang (raw rehmannia) to cool the blood, dan pi (moutan bark) to clear heat, and shao yao (white peony) to nourish yin. This formula treats heat toxin entering the blood level — when heat toxin breaks into the blood, all kinds of blood-heat signs appear: bleeding, disturbance of the mind causing delirium, and a tongue that is red-purple, sauce-purple — the “crimson tongue” (jiang she), along with blood in the urine and stool.
The scabs fall, but a new problem arrives: vomiting for a year, no bowel movement for over a year
The Xi Jiao Di Huang Tang worked — the pox slowly scabbed over and the scabs fell off, and the larger situation turned around. But right at that moment the patient suddenly started vomiting, and then his stool dried up — and this dragged on for about a year! He vomited at the drop of a hat, his stool was dry and wouldn’t come out, every doctor was helpless, and even Doctor Shi Jiquan couldn’t fix it.
💬 Note from Doctor Luo: Many people have felt this recently — after COVID, people tell Doctor Luo: “I never had this before. Why, after COVID, does food come right back up when I eat, up to my throat, with burps pushing upward?” This is heat that wasn’t fully cleared: heat entered the yangming and the residual heat was never completely removed — there is heat in the stomach pushing upward. The stomach’s proper movement is to descend; now heat is blocking it, and it also consumes body fluids — so you get vomiting on one side and constipation on the other.
Doctor Miao Xiyong looks at the tongue: cracks like a dried-up riverbed
At this point someone ran into Doctor Miao Xiyong and invited him to take a look.
Doctor Miao Xiyong held out his hand and asked the patient to stick out his tongue — and there it was: the tongue was covered in cracks.
💬 Note from Doctor Luo: Cracks on the tongue have their own diagnostic distinctions. Some are yin deficiency — the tongue is pale and tender with cracks on it. Others mean interior heat, dry heat — the tongue is a bit older and drier, the cracks are dried out, sometimes with a yellowish tinge. This patient’s tongue was clearly the latter. Doctor Miao Xiyong said: “Ci dang shi wei ceng jie yangming zhi re, gu you shi zheng” — “The yangming heat was never resolved back then; that’s why these symptoms exist today.” When an external pathogen penetrates into the foot-yangming stomach channel, it forms a yangming pattern — the pattern where the body mobilizes all its strength in a high fever to fight back — and the seat of the illness is the digestive tract, hence the vomiting and the dry, bound stool.
Sheng shi gao 30 g, ren shen 30 g: clear heat hard on one side, support upright qi hard on the other
How did he treat it? Doctor Miao Xiyong wrote: sheng shi gao (raw gypsum) 1 liang (30 g), ren shen (ginseng) 1 liang (30 g), mai men dong (dwarf lilyturf root) 5 qian (15 g), matched with pi pa ye (loquat leaf), ju hong (red tangerine peel), and zhu li (bamboo sap).
💬 Note from Doctor Luo: Large-dose raw gypsum started with Doctor Miao Xiyong — Zhang Zhongjing’s formulas already contained sheng shi gao, but it was Miao Xiyong who applied it in large amounts, and later Doctor Zhang Xichun learned from him. As for ren shen, 1 liang is 30 g — today almost no doctor dares prescribe 30 g of ginseng, afraid it’s too hot. But look: the ancients paired gypsum with ginseng — supporting upright qi on one side, clearing heat on the other, precisely because they feared the patient’s upright qi was insufficient, with qi and yin both deficient. The thinking is a bit like Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction).
Mai men dong nourishes the body fluids; pi pa ye cools and descends the lung qi; ju hong is tangerine peel with the white pith scraped off, opening the lung and relieving cough; zhu li clears phlegm-heat. Why regulate the lung? The lung and the large intestine are paired (fei yu da chang xiang biao li) — with the stool bound for over a year, opening the lung qi, descending the lung qi, and adding the power to clear phlegm-heat and move the bowels brings the stool down.
One dose settles it — but after two more, the diaphragm feels blocked by cold mist
How did it work? One dose settled it — after a single dose the symptoms were gone and the boy felt fine. Two more doses followed, but these two had a problem: the diaphragm felt as if something cold had blocked it off, wedged it shut.
At home, his parents were terrified at the sight and said: this medicine is going to kill our son! But Doctor Miao Xiyong was unshakable: “Bu fang, dang yi shen tang tou zhi” — “No problem. Give him a ginseng decoction.” So they decocted just over 1 liang of ren shen (30+ g) and gave it for two doses — after drinking it, the boy started to want food, and the diaphragm opened; by evening, the stool moved too. After a few more doses, every complaint was gone at once.
💬 Note from Doctor Luo: Watch Doctor Miao Xiyong’s rhythm. One dose at the start, and the situation is stable; two more doses, and it seems blocked — he doesn’t panic. The heat is already cleared; the remaining “cold mist” blocking the diaphragm tells him the upright qi is insufficient, so he gives a ginseng decoction to support upright qi — over 30 g of ginseng down, and it’s fixed. A very clean close. What’s the core? Supporting upright qi (fu zheng). Whatever external pathogen arrives, the reason you get infected is always that your upright qi was insufficient — the triggers here were just the marriage and the overeating. Not everyone who meets a pathogen gets infected; we all saw during the pandemic that plenty of people came through untouched.
Bonus: little formulas the ancients used for pox
Doctor Miao Xiyong was a hands-on physician, and his pox section preserves quite a few formulas: for pox wheezing (breathlessness during smallpox), bai hua di ding (white-flowered violet) decocted and drunk, even better with a little egg-white wine sipped alongside; for diarrhea after the pox, various formulas as well. And then there is Doctor Shi Jiquan’s family secret formula — for residual toxin after the pox, “as effective as magic”: ren shen (ginseng), fu ling (poria), jin yin hua (honeysuckle), xi jiao (rhinoceros horn), gan cao (licorice), ling yang jiao (antelope horn), and zhen zhu (pearl), made into honey pills.
💬 Note from Doctor Luo: Notice that this family secret formula also leads with ren shen. Some friends ask: why did they use so much huang qi (astragalus)? That’s for acute emergencies — when the situation is critical you reach for ren shen and huang qi; for slow, gradual tonification you can take your time. When you truly need to support upright qi, ren shen works very fast. So you see — doctors like Miao Xiyong and Shi Jiquan each had their own approaches — clearing heat, detoxifying, supplementing fluids, cooling blood — but supporting upright qi while expelling the pathogen (fu zheng qu xie) was always what they valued most. The Chinese people fought infectious diseases for a very long time and accumulated enormous experience — when an external pathogen arrives there’s no need to panic; whatever it is, we have many ways to regulate it, and the more you know, the better.
Compiled from Doctor Luo Dalun’s commentary on Doctor Miao Xiyong’s case records; the case comes from Xian Xing Zhai Medical Notes (《先醒斋医学广笔记》) by Doctor Miao Xiyong (Ming dynasty).