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Doulai (Severe Pox Scarring) is caused by the stagnation of heat-toxin and deficiency of Qi and Blood, leading to the decay of muscles. The *Classic* states: "When heat prevails, flesh rots." The *Zheng Lilun* states: "A pulse that is floating and large indicates strong Qi for the large aspect, but deficient Qi for the floating aspect. When wind and fire contend with each other, urticaria (hives) must form, causing itching in the body. This itching is named 'Xiefeng' (Wind Leakage). Over time, it becomes severe Doulai. Therefore, those whose Qi and Blood are ample will have no external deficiency-wind and no internal strong pathogen, and thus will not suffer from this disease. Only those who are constitutionally deficient in Qi and Blood cannot nourish the body with Ying and Wei Qi, making them susceptible to the killing energy of heaven and earth. Thus, deficiency-wind resides within the skin and flesh. Combined with the filth-toxin of pox, epidemic pestilence, and evil qi, which strike, contend, burn, and scorch, flowing and spreading everywhere, exiting through the pores, the sores were originally dense, leaving no intact skin on the body. The itching is unbearable, muscles ulcerate, and Doulai forms. One should urgently employ internal methods to greatly tonify Qi and Blood and clear heat-toxin, and externally apply Jiancan Jiuku San (Scar-Reducing Bitterness-Saving Powder) to preserve life. If it progresses to facial necrosis, nasal collapse, lip rupture, blindness, and limb injury, even if one survives, they will ultimately become a disabled person.

Why are there five types of pox that are untreatable? First, when there is itching, sinking, chills with teeth-chattering, and unquenchable thirst. Second, when the pox are purple-black accompanied by panting, thirst, and restlessness. Third, when the pox are grayish-white with sunken tops, abdominal distension, panting, and thirst. Fourth, when the head is warm, feet are cold, accompanied by mental confusion and desire to drink water. Fifth, when there is teeth-chattering, rapid breathing, diarrhea, irritability, and thirst. All these are untreatable.

When pox first appear with depression at the neck extending into red flesh, if by the ninth day the condition collapses entirely. If blood-heat accompanies purple macules, death occurs within six days. If black spots appear, death comes within morning or evening; if green spots appear, death follows instantly. Without pus, with itching and weakness, persisting twelve days, or accompanied by lower back pain and chest protrusion, these are untreatable. Conditions resembling hot water blisters or burns, with tongue retraction and scrotal contraction, mark the end of death. If purple blisters are punctured and black blood flows out, and food/drink obstructs the throat, all symptoms are ominous. Difficult to treat: facial swelling without pox swelling, green-purple-black sunken pox without pus. Free urination and defecation yet excreting intestinal sludge, along with vomiting, diarrhea, and roundworm expulsion. Warm head, cold feet, and preference for drinking water—all these are fatal signs indicating imminent death.