Library

Headache in smallpox is most alarming; the pathogenic toxin rushes upward, clearly distinguishing between wind-heat and fire-toxin patterns. For dense eruptions with high fever, Dalianqiao Yin (Great Lonicola Decoction) is indicated; for sparse eruptions with slight fever, Qingjie San (Clearing and Resolving Powder) is appropriate.

[Note]
Headache occurs when pathogenic factors contend with healthy qi, obstructing and suppressing the toxic qi from ascending to invade the clear orifices.
Therefore, both the upward rushing of toxic heat and the constraint of wind-heat can cause harm.
If the eruptions on the head and face are dense, accompanied by high fever, restlessness, confusion, and severe pain, this indicates the upward rushing of fire-toxin; it should be treated primarily with Dalianqiao Yin (Great Lonicola Decoction).
If the eruptions on the head and face are sparse, accompanied only by slight body heat and headache, this indicates constraint by wind-heat; it should be treated with Qingjie San (Clearing and Resolving Powder).
(The formula Dalianqiao Yin is found in the section on "Treatment of Crusting".)
(The formula Qingjie San is found in the section on "Treatment of Fever".)

%
Miscellaneous Syndromes in Smallpox

When smallpox is about to erupt but lower back pain precedes it, the fire-toxin is extremely hyperactive and yin fluids cannot overcome it. To prevent the toxin from transmitting to the Kidney meridian, Jiawei Guizong Tang (Modified Guizong Decoction) should be used promptly.

[Note]
Whenever lower back pain occurs during the fever stage of smallpox, it is a dire prognostic sign.
Since the lower back is the mansion of the Kidneys, when fire-toxin becomes extremely hyperactive, true yin cannot overcome the pathogen, resulting in frequent pain.
One must use Jiawei Guizong Tang (Modified Guizong Decoction) to rapidly purge the toxin, preventing its transmission to the Kidney meridian, so that survival may be hoped for.
If treatment is delayed even slightly, the fire-toxin will rush and blaze fiercely, causing the pustules to become dry, scabbed, purple, and black. Once Kidney yin is exhausted, rescue is difficult.
(Jiawei Guizong Tang [Modified Guizong Decoction]): Dangguiwei (Radix Angelicae Sinensis Caudex), Chishao (Radix Paeoniae Rubra), Yuanshen (Radix Scrophulariae), Sheng Dahuang (Radix Rhei Palmati Cruda), Qianghuo (Rhizoma Notopterygii), Jingjiesui (Fructus Schizonepetae), Chao Qingpi (Pericarpium Citri Reticulatae Viride Stir-fried), Zhi Chuanshanjia (Squama Manis Stir-fried), Shengdi (Radix Rehmanniae Glutinosae Preparata), Dongshancha (Fructus Crataegi Pinnatifidae Orientalis), Chaoyan Niubangzi (Fructus Arctii Stir-fried and Crushed), Mutong (Caulis Akebiae Trifoliate); decoct in water and take orally.
(Verse Formula)
Jiawei Guizong treats lower back pain,
Danggui, Chishao, Yuanshen, Sheng Dahuang.
Qianghuo, Jingjiesui, Qingpi, Chuanshanjia,
Shengdi, Shancha, Niubangzi, Mutong.

%
Miscellaneous Syndromes in Smallpox

In children with fever and abdominal pain, if caused by exterior constraint, Shaoyao Fangfeng Tang (Peony and Saposhnikovia Decoction) follows the pathogen; if caused by interior constraint, Jiawei Pingwei San (Modified Pingwei Powder) is used; if caused by yin constraint, Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) is effective.

[Note]
Abdominal pain during smallpox eruption may arise from wind-cold constraint, leading to slow eruption, irritability, and pain; this is exterior pathogen constraint,
treated primarily with Shaoyao Fangfeng Tang (Peony and Saposhnikovia Decoction).
It may also arise from food stagnation and interior obstruction; if there was no abdominal pain initially but sudden pain occurs during eruption,
this is interior constraint, treated appropriately with Jiawei Pingwei San (Modified Pingwei Powder).
Furthermore, if initially due to toxic heat constrained in the yin aspect, with pain below the umbilicus that comes and goes intermittently,
this belongs to yin constraint,
treated primarily with Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction).
(Shaoyao Fangfeng Tang [Peony and Saposhnikovia Decoction]): Shengma (Rhizoma Cimicifugae), Fangfeng (Radix Saposhnikoviae), Chenpi (Pericarpium Citri Reticulatae), Jiegeng (Radix Platycodonis), Chuanxiong (Rhizoma Chuanxiong), Chao Baishaoyao (Radix Paeoniae Albae Stir-fried), Sheng Gancao (Radix Glycyrrhizae Preparata Crude), Jiangchao Houpo (Cortex Magnoliae Officinalis Ginger-stirred), Fuchao Zhishi (Fructus Aurantii Immaturus Bran-stirred); decoct with fresh ginger juice and water.
(Verse Formula)
Shaoyao Fangfeng resolves exterior constraint,
Shengma and Fangfeng combined with Chenpi,
Jiegeng, Chuanxiong, Baishaoyao,
Gancao, Houpo, Zhishi are suitable.
(Jiawei Pingwei San [Modified Pingwei Powder]): Chenpi (Pericarpium Citri Reticulatae), Jiangchao Houpo (Cortex Magnoliae Officinalis Ginger-stirred), Chao Shenqu (Massa Medicata Fermentata Stir-fried), Nan Cangzhu (Rhizoma Atractylodis Lanceatae Soaked in Rice Wash Water and Stir-fried), Chao Maiya (Fructus Hordei Germinatus Stir-fried), Sheng Gancao (Radix Glycyrrhizae Preparata Crude), Zhixiangfumie (Radix Cyperi Rhizoma Processed), Nanshancha (Fructus Crataegi Stir-fried); decoct with fresh ginger juice and water.
(Verse Formula)
Jiawei Pingwei treats food injury,
Chenpi, Houpo, Shenqu, Cangzhu,
Maiya, Gancao, Xiangfumie,
Shancha decocted together with ginger juice.
(Guizhi Dahuang Tang [Cinnamon Twig and Rhubarb Decoction]): Sheng Dahuang (Radix Rhei Palmati Cruda), Guizhi (Ramulus Cinnamomi), Sheng Gancao (Radix Glycyrrhizae Preparata Crude), Baishaoyao (Radix Paeoniae Albae); decoct with fresh ginger and take.
(Verse Formula)
Guizhi Dahuang treats yin constraint,
Shengjun (Rhubarb) purges heat with extraordinary effect,
Sanhan Guizhi (Cinnamon Twig) harmonizes the middle with Gancao,
Baishaoyao harmonizes the middle and strengthens qi flow.

%
Miscellaneous Syndromes in Smallpox