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Wu Keyou stated: When epidemic pathogens remain in the blood level, causing stagnation and closure of the interior qi, purgation is required to manifest macules; once macules appear, the toxic pathogens can be resolved from the exterior. If macules gradually appear after purgation, strong purgation must not be used again. If there are still indications for purgation, a small amount of Chengqi Tang (Cassia Decoction) should be given slowly to induce mild purgation. If strong purgation is repeated, the primordial qi will collapse downward, leading to internal sinking of macule toxins, which is critical; at this time, Tuoli Jubang Tang (Decoction to Support Interior and Raise Macules) is indicated.

Wu's Tuoli Jubang Tang
Bai Shaoyao (White Peony Root, 1 qian) Danggui (Angelica Sinensis Root, 1 qian) Shengma (Cimicifugae Rhizoma, 0.5 qian) Chaihu (Bupleuri Radix, 0.7 qian) Baizhi (Angelicae Dahuricae Radix, 0.7 qian) Chuanshanjia (Pangolin Scales, 2 qian, roasted) Shengjiang (Fresh Ginger, 1 slice) The above seven ingredients are decocted in water and taken warm.

If after purgation the macule toxins remain hidden and do not emerge, instead presenting with symptoms such as grasping at bedclothes, staring fixedly, and picking at empty air, accompanied by a gradually faint pulse, the condition is critical. Adding Renshen (Ginseng Radix et Rhizoma, 3 qian) to the base formula to tonify qi and promote emergence of macules leads to survival; if tonification is insufficient, death ensues. During pregnancy with epidemic disease, even if San Chengqi Tangs (Three Cassia Decoctions) are necessary, treatment must be applied according to the specific presentation without excessive worry. One must not be confused by the theory that Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) secure the fetus. Patients' families may panic upon seeing Chengqi Tang used, and laypeople with superficial medical knowledge may interfere, causing obstruction, ultimately resulting in misfortune for both mother and child. If purgation is indicated but tonifying agents are used to secure the fetus, heat toxins will become more intense, making the fetus more unstable, consuming qi and blood, leaving no basis for the fetal sac. Thus, ancients used the metaphor of a bell hanging from a beam: if the beam rots, the bell inevitably falls. Only by using Chengqi Tang to expel pathogens, dissipating fire toxins, turning the interior cool, restoring qi, and naturally securing the fetus can safety be achieved. In such conditions, Dahuang (Rhei Radix et Rhizoma) becomes a sacred herb for securing the fetus; treatments have repeatedly succeeded, ensuring safety for both mother and child. If abdominal and lumbar pain appears, indicating imminent miscarriage, medication is futile, and this must be predicted in advance.

Fei Jianzhong said: A friend, Zhu Lianglao, had his wife pregnant for six months who developed macules in deep winter, restless and agitated, with body heat burning like fire. A friend encountered on the road advocated primarily regulating qi and nourishing blood to secure the fetus, assisted by Gancao (Licorice Root), Jiegeng (Platycodon Root), Niubangzi (Arctii Fructus), Chantui (Cicadae Periostracum), and Jingjie (Schizonepetae Spica) to release the muscle layer and vent the macules. After three days, although macules were not entirely unvented, the heat persisted like fire, with incessant irritability and thirst, coughing worsening into asthma, sleeplessness all night. By the fifth day, not only was sleep impossible, but lying down was unbearable; not only was breathing rapid, but speaking was impossible. The face was earth-colored, eyes stared fixedly, fingers were cold, craving watermelon, with six pulses nearly imperceptible. There was a sensation of the fetus descending, severe lower abdominal pain intolerable, restlessness everywhere, imminent death. The family cared only for the mother's survival. I had few suitable medicines, regretting not having a precise prescription, driven by compassion, I prescribed Dahuang (Rhei Radix et Rhizoma, 5 qian), Shigao (Gypsum Fibrosum, 1 liang), Huashi (Talcum, 7 qian), Shengdi (Rehmanniae Radix, 7 qian), Chao Hei Mahuang (Roasted Black Ephedra Herba, 0.3 fen), assisted by Chishao (Red Peony Root), Danpi (Moutan Cortex), Niubangzi (Arctii Fructus), Jingjie (Schizonepetae Spica), Dideng (Oldenlandia Herb), Mutong (Akebiae Caulis), Gancao (Licorice Root), Jiegeng (Platycodon Root). Decocted in Luzhu (Asparagus Fern Stem) soup instead of water. After two doses, symptoms slightly eased. A large watermelon was found and given intermittently for thirst. After another two doses, macules emerged again, symptoms halved, and the fetus ceased descending. The previous formula had Mahuang removed and continued for two doses; complexion improved, asthma settled allowing lying down, heat and thirst reduced by more than half, fetus safe, though cough persisted. The formula had Dahuang, Chishao, Danpi removed, Shigao and Huashi reduced by half, adding Yuanshen (Scrophulariae Radix), Tianhuafen (Trichosanthis Radix), Huangqin (Scutellariae Radix), Yinjinhua (Lonicerae Flos), for two doses. Heat and thirst resolved, stomach qi opened. This critical condition near death fortunately recovered, requiring further regulation; upon seeing health restored, medication ceased. Days later, fetal instability returned but without descent, food intake halved, residual heat remained, mouth sores appeared. Xiaoban Kaidu Tang (Decoction to Clear Macules and Rapidly Detoxify) with Chantui, Danpi, Chishao removed, Yinjinhua, Tianhuafen added, assisted by Xiaogansan (Powder to Eliminate Gum Rot) blown into the mouth, resulted in complete recovery. The decoctions used here are typically contraindicated in pregnancy, yet both mother and fetus were preserved. This demonstrates that when disease exists, it bears the treatment; not only is the fetus unharmed, but the efficacy of securing the fetus is revealed. Although macules and pox differ, the difference lies only in deficiency-type pox; severe toxic cases follow the same principle. In this case, saving the mother while fearing herbs like Dahuang created hesitation due to coexisting benefits and harms, yet both mother and child were saved. Physicians should deeply reflect and ponder this.

Xiaoban Kaidu Tang Treats pox complicated by macules or rashes, with skin red as if drunk.
Lianqiao (Forsythiae Fructus) Yuanshen (Scrophulariae Radix) Shengdi (Rehmanniae Radix) Niubangzi (Arctii Fructus) Mutong (Akebiae Caulis) Chantui (Cicadae Periostracum) Danpi (Moutan Cortex) Jingjie Sui (Schizonepetae Spica) Huanglian (Coptidis Rhizoma) Gancao (Licorice Root) Dideng (Oldenlandia Herb) Chishao (Red Peony Root) For extreme heat, add Dahuang (Rhei Radix et Rhizoma); add Dengxincao (Junci Medulla, 20 stems).

Xiaogan Jiedu San Powder to Eliminate Gum Rot and Detoxify Treats gum rot after pox or macules.
Bohe (Menthae Haplocalycis Herba, 0.5 fen) Ercha (Camelia Sinensis Catechu, 1 qian) Bingpian (Borneolum Syntheticum, 0.1 fen) Renzhongbai (Human Calculus, 3 qian) Tianhuafen (Trichosanthis Radix, 1 qian) Sheng Gancao (Raw Licorice Root, 0.5 fen) Fei Qingdai (Prepared Indigo Naturalis, 1 qian) Huanglian (Coptidis Rhizoma, 0.5 fen) Xi Niu Huang (Calculus Bovis, 0.1 fen) Zhuzi Fen (Pearl Powder, 0.2 fen) Yuqian Cha (Pre-Mineral Spring Tea, 0.5 fen) Pengsha (Borax, 1 qian) Grind to extremely fine powder, until silent. First wipe clean with strong tea, then blow into the lesion.

The upper volume concludes with ancient narratives.