Abstract: Objective To review ancient Chinese medical literature on monkeypox in terms of the disease name, etiology, pathogenesis, syndrome differentiation and treatments. Methods Literature on monkeypox from ancient Chinese medical texts was reviewed. Analysis was conducted of the clinical data on the etiology pathogenesis, principles and methods of treatment, syndrome differentiation and treatment by stages, pharmacology, and external treatment with TCM related to 8 cases of monkeypox admitted to Shenyang Sixth People's Hospital between June 29, 2023 and February 5, 2024. Results During clinical research on monkeypox using TCM, it was found that the pathological mechanism and clinical manifestations of monkeypox were highly consistent with the category of “epidemic diseases” "variola" in traditional theories of TCM, and that the disease resembled smallpox. The etiology and pathogenesis of monkeypox were believed to be due to external contraction of epidemic toxins prevalent at the time, and with damp-heat accumulations in lungs and spleens. Based on the course of disease, monkeypox was divided into three stages: the initial stage, around 7 days after rash onset, and more than 14 days after rash onset. According to different stages of the disease, treatments involved dispersing wind and clearing heat, relieving the exterior and promoting the eruption of rashes, strengthening the spleen and eliminating dampness, and enhancing the body's resistance to eliminate pathogens. A modified prescription of Shaoyao Guizhi Gancao Tang (Paeoniae Radix, Cassiae Twig, and Glycyrrhizae Radix Decoction) was used in combination with Shenling Baishu San (Poria, Atractylodes, and Coicis Semen Powder) , Sijunzi Tang (Astragalus, Atractylodes, Ginseng, and Poria Decoction) along with Chaige Jieji Tang (Bupleurum, Pueraria, and other herbal decoction) , Bazhen Tang (Eight-Treasure Decoction) combined with Fangfeng Tongsheng San (Saposhnikoviae and other herbal powder). External treatments with TCM such as thunder-fire moxibustion and Chinese herbal decoction soaking were also adopted. Conclusion Based on the disease characteristics of monkeypox at different stages, TCM treatment strategies intended to resolve exterior syndrome and promote eruption, strengthe the spleen to eliminate dampness, and promote the body resistance to eliminate pathogenic factors have been adopted to good clinical effects.

Key words: Variola, Smallpox, Monkeypox, Epidemic Pathogenic Factor, Etiology and Pathogenesis, Men who Have Sex with Men HIV, AIDS