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In the context of smallpox, dry hiccups indicate a severe disease progression. This condition is caused by the upward reversal of toxic heat. Although purgative methods are generally contraindicated for patients with deficient righteous qi, if the pattern is excess heat, Chuanpi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) should be used; if the pattern is deficiency-cold, Dingxiang Shidi Tang (Clove and Persimmon Calyx Decoction) is miraculous.

[Note]
Dry hiccups refer to a state where there is sound but no vomitus. The sound is loud and prolonged, indicating involvement of the Yangming Stomach Meridian. The etiology is primarily due to the upward reversal of toxic heat. Alternatively, it may result from insufficient Stomach Qi, which fails to accommodate and receive, compounded by cold pathogens lodging in the Stomach. This prevents Stomach Qi from ascending properly, thereby causing hiccups. For heat patterns, Chuanpi Zhuru Tang is the primary formula; for cold patterns, Dingxiang Shidi Tang is the primary formula.

(Chuanpi Zhuru Tang [Tangerine Peel and Bamboo Shavings Decoction]) Ingredients: Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, prepared with ginger), Maimendong (Ophiopogonis Radix, heart removed), Pipaye (Eriobotryae Folium, roasted with ginger), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Zhuru (Bambusae Caulis in Taeniam), Chiling (Poria), Renshen (Panacis Ginseng Radix). Decoct with Luzhen (Phragmitis Rhizoma) water as a reference.

(Fangge [Prescription Song])
Chuanpi Zhuru Tang works like magic,
Specially treating frequent vomiting and counterflow due to Stomach heat.
It contains Tangerine Peel, Pinellia, Ophiopogon, Loquat Leaf, Licorice,
Bamboo Shavings, Poria, and Ginseng.

(Dingxiang Shidi Tang [Clove and Persimmon Calyx Decoction]) Ingredients: Dingxiang (Syzygdii Aromatisati Flos), Renshen (Panacis Ginseng Radix), Gaoliangjiang (Alpiniae Officinarum Rhizoma), Shidi (Diospyri Calyx). Decoct with water.

(Fangge [Prescription Song])
Dingxiang Shidi Tang treats cold patterns,
Addressing Stomach Qi counterflow that causes unrest.
Clove, Galangal, and Ginseng are combined,
Along with Persimmon Calyx, decocted together.

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Miscellaneous Syndromes in Smallpox

For vomiting caused by excessive toxicity in smallpox, Erchen Tang (Two-Aged Decoction) is effective. For difficulty in swallowing, Shuniu Tang (Arctii Decoction) is indicated. For vomiting of sour fluid due to food stagnation, Muxiang Da'an Wan (Aucklandia Great Peace Pill) is efficacious. For vomiting due to Qi deficiency, Hewei Fang (Harmonize the Stomach Formula) should be used.

[Note]
Ou (vomiting with sound) involves both sound and vomitus, whereas Tu (spitting up/vomiting without sound) involves vomitus without sound. Both syndromes belong to the Stomach.
During the initial eruption stage of smallpox, vomiting is caused by Fire Pathogens invading the Stomach and Toxic Qi surging upward. In this case, the pustules will appear red or purple, and Zhilian Erchen Tang (Gardenia and Coptis Two-Aged Decoction) is appropriate.
From the swelling stage to the crusting stage, vomiting occurs because the sores accumulate at the pharynx, causing difficulty in swallowing. Shuniu Zi Tang (Arctii Seed Decoction) must be used.
If vomiting is due to food stagnation, the vomitus will have a fishy and sour odor; Muxiang Da'an Wan is suitable.
If after vomiting the patient appears listless and has no appetite, this indicates Stomach Qi deficiency. Shen Sha Hewei Tang (Ginseng and Amomum Harmonize the Stomach Decoction) should be administered.

(Zhilian Erchen Tang [Gardenia and Coptis Two-Aged Decoction]) Ingredients: Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, stir-fried with ginger), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Zhizi (Gardeniae Fructus, stir-fried with ginger), Chuanhuilian (Coptidis Rhizoma, stir-fried with ginger). Decoct with Shengjiang (Zingiberis Rhizoma Recens) water as a reference.

(Fangge [Prescription Song])
When Toxic Qi rushes to the Stomach causing frequent vomiting,
Treatment requires the use of Erchen Tang.
It includes Tangerine Peel, Pinellia, Poria, and Raw Licorice,
With Gardenia and Coptis stir-fried with ginger, proving as effective as divine intervention.

(Jiawei Shuniu Zi Tang [Modified Arctii Seed Decoction]) Ingredients: Jiegeng (Platycodonis Radix), Shegan (Belamcandae Rhizoma), Lianqiao (Forsythiae Fructus, heart removed), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Shandougen (Sophorae Tonkinensis Radix), Shuniu Zi (Arctii Fructus, stir-fried and ground), Gange (Puerariae Radix). Decoct with water.

(Fangge [Prescription Song])
The Modified Arctii Decoction is highly appropriate,
Combining Platycodon, Belamcanda, and Forsythia.
Schizonepeta and Saposhnikovia are added,
Along with stir-fried Arctii seed paired with Kudzu root.

(Muxiang Da'an Wan [Aucklandia Great Peace Pill]) See the section on Convulsions.

(Shen Sha Hewei Tang [Ginseng and Amomum Harmonize the Stomach Decoction]) Ingredients: Renshen (Panacis Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with earth), Huoxiang (Agastaches Herba), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, prepared with ginger), Suosharen (Amomi Fructus), Gancao (Glycyrrhizae Radix et Rhizoma, honey-roasted). Decoct with Weijiang (Zingiberis Rhizoma Praeparatum) water as a reference.

(Fangge [Prescription Song])
For deficiency-type vomiting, Shen Sha Hewei Tang is used,
Comprising Ginseng, Atractylodes, and Agastache.
Poria, Tangerine Peel, and Prepared Pinellia are included,
With Amomum and Licorice, guided by Roasted Ginger.

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Miscellaneous Syndromes in Smallpox