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In cases where smallpox or chickenpox lesions are in the stage of impending or completed crusting, but suddenly fail to crust, accompanied by abdominal distension, restlessness, and thirst, Shiyiwei Muxiang San (Eleven-Ingredient Costus Root Powder) should be administered urgently.

My commentary: Regarding the aforementioned symptoms, if they are accompanied by aversion to cold or cold limbs, it indicates that although the pathogenic toxin has been expelled, the Spleen and Stomach are deficient and cold; the aforementioned medicine (Shiyiwei Muxiang San) is appropriate. If there are symptoms such as coldness extending up to the ten fingers and teeth grinding, this signifies the collapse and sinking of Yang Qi; Shierwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) should be used. In cases of Spleen Qi deficiency with sinking, Liujunzi Tang (Six-Gentleman Decoction) should be used, supplemented with Chuanxiong Rhizoma (Chuanxiong), Danggui Radix (Danggui), and Huangqi Radix Astragali (Huangqi). ○ A nine-year-old child developed smallpox. On the seventh day, fever and restlessness occurred. The lesions failed to suppurate, appeared grayish-white, and were accompanied by chills, teeth grinding, diarrhea, thirst, abdominal distension, and cold extremities. Although it was midsummer, drinking boiling water did not feel hot, and the abdomen felt cold internally. Initially, two doses of Muxiang San were administered, which worsened the condition. Subsequently, one dose of Yigong San was given, resulting in immediate relief. Then, Liujunzi Tang with three qian of Fuzi Radix Preparata (Fuzi) was used for two doses, followed by regulatory and tonifying agents. The child recovered on the fourteenth day.

In cases where smallpox lesions are in the stage of impending or completed crusting, sudden warmth of the head and face combined with cold toes, or abdominal distension, diarrhea, thirst, and rapid breathing occur, Shierwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) should be taken urgently. If on the eleventh or twelfth day, when crusting should occur, it does not happen, and the body lacks high fever, accompanied by mental agitation and restlessness, gasping while lying down, restlessness, thirst, and teeth grinding, Shierwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) supplemented with Danggui Radix (Danggui) and Atractylodis Macrocephalae Rhizoma (Baizhu) should be administered urgently to rescue the imbalance of Yin-Yang and interior-exterior.