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Dengue maggots refer to insects formed from pus and blood, generated by the transformation of damp-heat qi. This condition often occurs in summer cases of smallpox where the progression is slow. However, if such maggots appear on even aesthetically good lesions, severe itching will inevitably ensue. Externally, it is appropriate to remove them with a silver hairpin, or wash with decoctions made from mulberry leaves that have been frosted, or wild mint; this will naturally cause the maggots to disappear and the itching to cease. Some claim that patients with maggot-infested lesions do not die because the malignant toxins are fully expelled to the exterior. Others argue that such patients must die, analogous to how worms arise only from rotting matter; one should observe the quality (good or bad) of the lesions to verify the prognosis.

Water and fire are the traces of Yin and Yang. Kan and Li represent the positions of water and fire, respectively. The Heart and Kidney correspond to the pairing of Kan and Li. Yin roots in Yang, and Yang roots in Yin; they serve as mutual foundations, enabling transformation and combination to generate all things. Thus, the Heart corresponds to Li and generates Blood; this is Yin within Yang, constituting True Yin. The Kidney corresponds to Kan and generates Qi; this is Yang within Yin, constituting True Yang. The Blood in the Heart is essentially the True Water of the Kidney, providing irrigation and nourishment, which reflects the virtue of Water. The Qi in the Kidney is essentially the True Fire of the Heart, providing inspiration and agitation, which reflects the image of Fire. However, Water is benevolent while Fire is malevolent. Moreover, in the two Kidneys, the left belongs to Water and the right to Fire. The *Classic* states: "Beside the seventh vertebra, there is a 'Small Heart'." This 'Small Heart' refers to the Ministerial Fire of the Mingmen (Gate of Life). It is called 'Small Heart' because it acts as the assistant to the Sovereign (Emperor), and it is called 'Mingmen' because it executes the Sovereign's commands. With one body of Water standing between two fires, its inability to withstand the fire is obvious. What regulates this balance in the middle, preventing the fire from becoming excessive and the water from drying up, is the 'Shen' (Spirit) that governs it. What is this 'Shen'? It resides in the Great Void. However, Water and Fire cannot coexist without regulation; slight imbalance in their preservation leads to fluctuations in dominance and decline. Especially since the fire of sores and rashes originates below the Mingmen, combining with another fire. What is described as 'assisted' implies strength. Therefore, the Ministerial Fire joins the momentum of the Sovereign Fire, acting recklessly and destructively, consuming and burning everything. The Way of Yang is inherently deficient; once the fire flares up intensely, the True Water perishes. Once True Water perishes, body fluids abruptly cease, causing Qi stagnation. The skin and hair become dry and withered, unable to moisten the integument or nourish the interstices. The blood within the lesions dries and turns black. This change to black occurs because blood is originally red but turns black when dried. It is termed 'Returning to the Kidney' because blood is originally Yin-Blood of the Kidney, and at this stage, Kidney Water is also exhausted. This is a symptom of Kidney Deficiency. How could there be a principle of Kidney Excess causing evil? Why does the world use herbs to drain the Kidney? Furthermore, the Kidney primarily manifests deficiency! Qian Yi (courtesy name Zhongyang), the ancestor of pediatric medicine, formulated Baixiang Wan, which drains Water from the Bladder. Considering the recovery of Spleen and Stomach function, later generations speculated on Qian Yi's intent, but this may not reflect his original formulation logic. Unbeknownst to them, Daji (Euphorbiae Humifusae Radix) is also an herb that drains the Small Intestine. The Heart and Small Intestine are interior-exteriorly related. By draining the paired organ (Small Intestine) rather than directly draining the Heart, Heart Fire descends and Kidney Water ascends, achieving the Tao of Yin-Yang interaction. Toxins are removed while True Qi remains intact, leading to survival in many cases. Moreover, Daochi San was also formulated by Qian Yi and similarly drains the Small Intestine, differing from Baixiang Wan only in mildness versus potency. If one insists on viewing Baixiang Wan as draining the Bladder and applies the theory of 'draining the son when the mother is excess,' then black depression might seem like Kidney Excess. However, this contradicts the nature of materia medica and leads to grave errors.

Generally, objects growing underground are red; as they grow slightly, they turn white; withering makes them yellow; and desiccation makes them black. Infants are red at birth, turn white as they grow, yellow when ill, and black upon death. All things rely on a single pulse of Yang Qi for life. These four colors represent the variations of this single Yang Qi. Smallpox progresses from eruption to development, from development to pustule formation, and from pustules to scabbing; this is the circulation of Yang Qi within the body. Relating this to the four seasons: the initial red eruption corresponds to the Spring command of generation; the whitening during development corresponds to the Summer command of growth; the yellowing into pustules corresponds to the Autumn command of fruition; and the blackening into scabs corresponds to the Winter command of storage. If eruption is black, it is Winter's command acting in Spring. If development is black, it is Winter's command acting in Summer. If pustule formation is black, it is Winter's command acting in Autumn. If scabbing fails to form and pus infiltrates, it is Spring/Summer commands acting in Winter. These deviations from the sequential order are termed 'Reverse' (Ni). There are two types of black smallpox: one is dry and black, named 'Inverted Depression' (Dao Xian), caused by excessive pathogenic fire and exhaustion of True Water; this is the 'Returning to Kidney' syndrome and is incurable. The other type is black in color but not yet dry or fragile; this is due to epidemic toxin described as 'fire flare-up causing obscuration.' Treatment may involve Gui (Angelicae Sinensis Radix), Baiye (Platycladi Cacumen), Shengdi Huang (Rehmanniae Radix), Chi Shao (Paeoniae Radix Rubra), and Jiu Honghua (Carthami Flos prepared with wine) to cool Blood; Huangqi (Astragali Radix), Renshen (Ginseng Radix), and Sheng Gancao (Glycyrrhizae Radix et Rhizoma Preparata) to clear fire and tonify Yuan Qi; Jiuhuang Qin, Huanglian (Coptidis Rhizoma), Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), and Shengma (Cimicifugae Rhizoma) to resolve toxicity; Fangfeng (Saposhnikoviae Radix) and Jingjie (Schizonepetae Spica) to release the exterior; plus one qian of burnt human feces, administered continuously for over ten days, often resulting in survival.

The toxin of smallpox and rashes emerges from within, disrupting Qi and Blood, and expanding the interstices. The initial drop of blood is simply the body's own Qi and Blood driven out by the toxin to the skin surface. Thus, the shape is formed by Qi, and the color by Blood. If toxic fire is too intense, it boils Qi and Blood; the arriving Qi is depleted, and the arriving Blood is dried up. Depleted Qi and dried Blood cause the lesion color to turn black, and the interstices close reversely, trapping the toxin inside. It re-enters the interior, forming depression and伏藏 (hidden retention). This is caused by toxin stagnation, unlike external wind-cold invasion, internal deficiency with vomiting/diarrhea, or miscellaneous qi contact. A skilled physician handling this should purge if indicated, promote urination/bowel movement if indicated, or induce sweating if indicated; resolve interior or exterior syndromes accordingly, adapting with ingenuity, without rigid adherence to standard methods. At that time, black lesions were feared terms like 'Ghost Smallpox' or 'Smallpox Carbuncle'; urgent treatment is essential to prevent spread.

If ordinary sores remain unhealed, or scars are tender after healing, when smallpox erupts, toxin may accumulate excessively at certain sites, clustering into patches that are black and ulcerated. These require immediate puncture with needles, suction of toxic blood, and treatment with Sisheng San. If lesions are scorched black all over, check the stool. If constipated, administer Chengqi Tang internally and bathe in warm Shuiyang Decoction externally. If bowel movements are free, administer Shiquan Dabu Tang internally and bathe in warm Shuiyang Decoction externally. Some attribute this to Kidney Deficiency, others to Kidney Excess. In essence, Deficiency involves weakness of Righteous Qi, while Excess involves abundance of Pathogenic Qi.