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(Thirty-one poems in total, comprising forty-six prescriptions)

Q: Why do carbuncles (carbuncle) occur after smallpox? It is solely because the lesions are flat and fail to suppurate, causing toxic pathogens to accumulate and gather, making them difficult to dissipate. One must penetrate the joints and seek key acupoints to discharge the vital passages.

When smallpox first appears, it starts as a drop of blood, which transforms into pus from the blood. Once pus forms, the toxic pathogen is resolved. If after eruption, the lesions should rise but do not, or should suppurate but do not, presenting as empty shells resembling snake skin, or being flat, collapsed, and broken with no pus or fluid, this is originally a death syndrome. However, if the person's Spleen and Stomach are inherently strong and they can eat, one can wait for recovery over time. The toxic pathogen accumulates internally and must find an exit between the joints, forming carbuncles. If only one or two areas erupt, it is treatable; if it flows to the hands and feet, erupts incessantly, and swelling persists without healing, death will ensue after a long period.

For post-smallpox carbuncles, one must first clarify the meridians, resolve toxicity, regulate Yuan Qi, and employ interior support. Draining pus to remove toxicity requires urgent action; do not wait until the damaged form becomes a malignant condition.

Whenever a carbuncle erupts, first observe which meridian it affects and treat according to the abundance or scarcity of Qi and Blood. Next, assess the patient's deficiency or excess, prioritizing detoxification and interior support. Do not indiscriminately apply external plasters, which may prevent the toxin from exiting and cause internal inflammation of muscles and bones, leading to a disastrous condition. For swelling that has not yet formed pus, apply Bisheng Gao (Victory Paste). For those where pus has formed, pierce it with a Pi Zhen (Bich Needle) to drain the pus, then apply Shengji San (Flesh-Regenerating Powder). If the swelling/toxicity occurs in someone with inherently weak Yuan Qi, use Shi Liu Wei Liuqi Yin (Sixteen-Ingredient Flowing Qi Decoction) to circulate Qi. If there is Qi and Blood deficiency accompanied by diarrhea, add Fuzi (Aconite Root) to warm. If Yuan Qi is inherently strong, use Lianqiao Jiedu Tang (Forsythia Detoxification Decoction) as the main treatment. If the carbuncle/toxicity has persisted for a long time with significant loss of pus and blood, use Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) to support Yuan Qi and resolve toxicity.

Among malignant conditions, none are worse than Danliu (Red Fire Carbuncle) after smallpox, where fire-toxin accumulates in the skin and interferes with each other. Observe which region it affects; treatments for Heart and Kidney meridians are also difficult.

Chi Huo Danliu (Red Fire Carbuncle) is a malignant sign, characterized by flowing redness and swelling, with pain so severe that the hand cannot bear to touch it. After smallpox, some develop Danliu due to excessive accumulation of fire-toxin that cannot vent, stagnating between muscles, thus manifesting as Dan Du (Carbuncle). If it starts from the head and crosses the Heart meridian, death ensues; if it starts from the feet and crosses the Kidney meridian, death ensues. Internally administer Xuanshen Huadu Tang (Scrophularia Detoxification Decoction) to resolve it; externally use Ci Feng Bian Fa (Magnetic Edge Cupping/Bloodletting Method).

Why does Yin Zhen (Urticaria/Rash) appear after smallpox? Because the toxin retained in the skin and muscles has not been fully cleared. If allowed to erupt completely without stagnation, it prevents the emergence of various strange syndromes.

"Yin" refers to hidden bumps under the skin, commonly called Feng Dan (Wind Carbuncle); "Zhen" refers to dot-like marks on the skin resembling mosquito bites. Post-smallpox urticaria/rash occurs because the fire-toxin has not fully erupted and hides between the skin layers, or arises from scratching due to itching, or from wind-fire interaction. These are auspicious signs, indicating a desire for venting; do not let them stagnate and transform into other syndromes. If eruptions are too severe, internally administer Fangfeng Baidu San (Saposhnikovia Resolving Toxin Powder) and externally wipe with Yiyuan San (Benefit Origin Powder). See previous text for the formula of Yiyuan San.

Smallpox has scabbed but remains dry, occasionally bleeding, making the illness unstable. Previously, toxic vapors hid in the muscle surface, corroding flesh and damaging skin, unbearable to look at.

This is similar to the stubborn sores mentioned earlier. Whenever smallpox fails to scab when it should, guard against this syndrome. Internally administer Dabu Tang (Great Tonifying Decoction) and externally apply Mianjian San (Silkworm Cocoon Powder). See previous text for the formula of Mianjian San.

Why do nebulae accumulate inside the eyes? Blame heat-toxin congesting in the Liver. There are miraculous techniques for restoring vision and removing nebulae; mere washing and dropping merely leads to uselessness.

When children have smallpox, Huangbai Gao (Phellodendron Paste) mixed with Zhigan (Alkermes) is applied to the eyes to prevent lesions from entering the eyes. However, lesions entering the eyes usually do not happen initially but during the scabbing phase. Or if the face is extensively ulcerated and swells again with sticky pus and blood, internal郁蒸 (stagnant steaming) of fire-toxin causes lesions to enter the eyes. Or if smallpox erupts excessively and matures slowly, doctors use acrid-hot herbs to induce sweating, also causing lesions to enter the eyes. Or during scabbing, preference for bland acrid-hot foods, called Gan Jiang (Dry Pus), causes dual fires to fan each other, also causing lesions to enter the eyes. Treatment is unnecessary for white pearls (sclera) as they disappear naturally over time; only for black wheels (cornea/pupil area), especially if obscuring the pupil, urgently use Mimenghua San (Cacalia Flower Powder).

Both eyes suddenly fear light today; Liver deficiency and evil fire secretly damage the pupils. Cooling the Liver and nourishing Blood has unparalleled merit, making both eyes clear and bright.

Whenever post-smallpox eyes refuse to open in bright light but open in darkness, it is called Xiuming (Shyness to Light), treated with Liangganning Mingmu San (Cooling Liver Brightening Eyes Powder). If they do not open even in darkness, guard against ulcers in the eyes and treat as above.

Why does red stool occur after scabbing? Mostly due to inversion causing toxins to return to the center. After purging pus and blood, it should heal; forcing cessation creates a gathering of resentment/toxins. With pus, blood, and scabs coming together, let it stop naturally without suspicion. Harmonize the middle and clear heat as a finishing move; lightly using astringents aggravates the disease.

Suddenly experiencing pus and bloody diarrhea after smallpox, wait for it to stop naturally, then use harmonizing and heat-clearing agents; do not immediately use astringents. However, for severe dysentery, use Huanglian Jiedu Tang (Coptis Detoxification Decoction) to clear and resolve; after pus and blood cease, use Hezhong Tang (Harmonize Middle Decoction).

If there was no inversion in the smallpox course, why is there endless pus and bloody diarrhea? Large Intestine stagnant fire harbors hidden toxins; resolving toxicity and unblocking the intestines is best done early.

Smallpox presents no inversion syndrome, yet there is dysentery with pus and blood. This is due to habitual consumption of fried foods, creating accumulated heat. Now, due to Qi and Blood deficiency after smallpox, unable to overcome the accumulated heat, dysentery with pus and blood occurs, named Zhixia (Stagnant Downfall), inevitably with borborygmus, pain, tenesmus, and heaviness in the rectum. Or due to overeating after eruption, water retention causing diarrhea, heat-toxin enters the interior through deficiency, resulting in pus and bloody stool, named Changgou (Intestinal Mucus). Use Tiaowei Chengqi Tang (Regulate Stomach Purgative Decoction) to eliminate its toxicity, followed by Huangqin Tang (Scutellaria Decoction) to harmonize Yin and Yang.

Most feared is frequent vomiting and hiccups after scabbing; sore throat and weak Stomach allow toxins to lurk. Choking on food/water requires treatment; silent hiccups signal imminent death.

Vomiting with sound and matter is Ou (Vomit); matter without sound is Tu (Eject); sound without matter is Yue (Hiccup). Vomiting immediately after eating is Cuo Hou (Throat Error); spraying upon drinking is Qiang Shui (Water Choke). Now, post-smallpox occurrences of these are due to heat-toxin blocking the Stomach gate, causing vomiting; throat obstruction causes choking. Only dry heaving indicates Stomach ulceration/rottenness, inability to accept food, opening mouth frequently, seeming to vomit but not, which is untreatable. Also, sore throat with vomiting and loss of voice indicates throat rot, also untreatable. For simple vomiting, use Chenpi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction); for sore throat, use Ganjie Tang (Licorice and Platycodon Decoction).

Body is calm but heat persists; either due to severe toxin or deficient Yuan Qi. Regulate Yuan Qi and resolve toxicity separately; clear distinction between cold and heat yields natural efficacy.

Once smallpox has scabbed, toxin is resolved and heat should cease. If heat persists, it is either residual violence of toxic vapors or inherent deficiency of Yuan Qi. Differentiate by pulse: if pulse is rapid, constitution vigorous, irritable and hot, it is excess of pathogenic qi, use Zhimu Jiedu Tang (Anemarrhena Detoxification Decoction); if pulse is slow, constitution timid, hot and sleepy, it is deficiency of healthy qi, use Huangqin Tiaoyuan Tang (Scutellaria Regulate Origin Decoction).

After scabbing, body is consistently warm, suddenly feverish—examine carefully. Internal injury and external contraction require different treatments; this true mechanism is a wonderful gate.

After scabbing, the body is consistently warm and peaceful with no residual heat. Now sudden fever should not be equated with unresolved residual toxin or deficiency of healthy qi, but must be due to external contraction of Wind-Cold. Symptoms include dizziness, headache, aversion to cold, and floating pulse; use Guizhi Tang (Cinnamon Twig Decoction).

Or due to internal dietary injury, symptoms include abdominal fullness and distension, dislike of food, wiry and slippery pulse; use Buzhong Yiqi Tang (Tonify Middle Augment Qi Decoction) added with digestive herbs.

Diet and drink are normal but abdomen hurts; covered by weak Spleel and difficulty digesting. Assess deficiency or excess for digestion; only then does the skilled physician show mastery.

After scabbing, sudden abdominal pain, or vomiting/diarrhea, loss of appetite, this is Food Injury syndrome. For deficiency, use Buzhong Yiqi Tang; if no vomiting, diarrhea, abdominal pain, or急促 breathing, use Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill). If abdominal fullness and pain, restlessness, this is fire-toxin entering the center, urgently use Xionghuang Jiedu Wan (Realgar Detoxification Pill); otherwise, gradually worsening panting and cold extremities become difficult to treat.

Why no appetite after scabbing? Occasional food injury is rarely known. Tonify Spleen and promote digestion is the good method; enduring it leads to infantile malnutrition (Gan Syndrome), regretting too late.

Previously able to eat, now unable after scabbing, smelling food causes nausea/vomiting; this must be food injury. Severe cases use Pi Ji Wan (see previous), mild cases use Baohe Wan (Preserve Harmony Pill) to regulate. If endured without urgent treatment, emaciation follows, gradually becoming Gan Lao (Malnutrition Consumption).

Chills and fever entangle the body like malaria, arriving on schedule regardless of day or night. Only due to Spleen and Stomach weakness; tonifying Qi and raising Yang requires discretion.

This is due to dual injury of Qi and Blood after smallpox; Yin deficiency causes internal heat, Yang deficiency causes external chills, alternating chills and fever resembling malaria. Do not treat as malaria; instead, use Buzhong Yiqi Tang to raise and lift, and the illness heals itself.

After scabbing, whole body and extremities are cold; view as Qi and Blood deficiency. Six pulses fine as if about to depart, urgently restore Yang and the illness calms.

After smallpox scabbing, cold extremities, deep and fine six pulses, great deficiency of Yuan Qi, urgently use Tiaoyuan Shengmai San (Regulate Origin Generate Pulse Powder) to warm; slight use of cold/cool herbs leads to defeat and death.

Struggling spirit but sleepy and confused, why all day not alert? This is due to resolved toxin, deficient Shen (Spirit), and fatigue; Qi and Blood peaceful, body naturally tranquil.

Sleeping well after scabbing is due to resolved toxin and deficient Shen, a common occurrence, requiring no treatment. Some opportunistic people deceive the ignorant for profit; mediocre practitioners recklessly use decoctions and pills causing disaster. Beware! Beware!

Deep sleep unaware of people, hallucinating drunkenness and frequent nonsense speech. Only because heat hides in Pericardium Luo; protecting the Heart Monarch is miraculous.

Post-scabbing coma, unconscious for days, speaking nonsense, or waking up looking drunk and speaking wrongly, this is Heat Evil attacking the Heart. The Heart Monarch refuses to accept evil, transmitting to the Pericardium Luo; use Daochi Jiedu Tang (Guide Out Red Detoxification Decoction) to clear, or Anshen Wan (Calming Spirit Pill) is also good.

Convulsions persist after scabbing; blame fire-toxin not fully cleared. Clear Heart and scatter fire, wind should retreat; continuous发作 leads to inevitable collapse.

Fever and convulsions during smallpox eruption are common. If convulsions recur after scabbing, it is because sores did not fully erupt and fire-toxin invades internally. However, this syndrome occurs after scabbing when Qi and Blood are already depleted, making treatment very difficult; use Qingshen Sanhuo Tang (Clear Spirit Scatter Fire Decoction). If the medicine matches the disease, it is treatable; if continuous convulsions, it is a death syndrome.

Body is healthy but limbs contract; clearly caused by Blood deficiency leading to this error. Tonify Spleen and nourish Blood is truly a divine secret; do not spread it rashly without knowing friends.

Sudden limb contraction/inability to flex/extend after smallpox is due to Blood deficiency failing to nourish tendons, or external contraction of Wind-Cold-Water-Dampness. Do not use dispersing or wind-dispelling herbs to consume Blood; only use Danggui Guizhi Tang (Angelica Cinnamon Twig Decoction) to tonify Spleen and nourish Blood, then limbs naturally harmonize.

Still worried about much coughing after smallpox; total grinding by fire-toxin in the Lungs. Clear Metal, descend fire, and regulate Qi; shoulder breathing and high chest, what hope for life!

After measles/smallpox, only the Lungs are injured. Upon scabbing and toxin resolution, it should be calm. If instead coughing and panting accelerate, fire-toxin has flowed into the Lungs; clear Metal and descend fire, use Ningfei Tang (Pacify Lung Decoction) to protect Lungs and resolve toxin. If cough persists after medication, with high chest, turtle-shell appearance, and shoulder breathing, it is untreatable.

Sudden whole-body swelling shape; either Wind or Water or Food stagnation. Swelling due to Lung involvement should be cleared and released superficially; distension belonging to Spleen should be resolved by draining.

After smallpox scabbing, facial/limb edema belongs to the Lung. Due to exterior deficiency contracting Wind-Cold, still suitable for sweating resolution, use Jiawei Wupi Tang (Modified Five Peel Decoction).

If abdominal distension like a drum, eyelid slight swelling, this belongs to the Spleen. Due to Spleen/Stomach deficiency, excessive drinking, dampness accumulating internally, excessive eating, heat accumulating in the center, still suitable for draining resolution, use Nongpo Tang (Thick Bark Decoction); if it is deficiency distension, do not attack blindly, only use Laifuzi Wan (Radish Seed Pill).

Urine should be clear; occasional delay/stagnation, little knows bladder heat accumulation. Not using Daochi as a good method, fear delay brings changes.

For all smallpox/measles, urine should always be clear. If difficult after scabbing, this is heat accumulating in the Bladder; use Jiajian Daochi San (Modified Guide Out Red Powder) to clear the Heart.

Stool prefers moistening/nourishing; suddenly feels difficult, who knows intestinal fluids are dry? Moistening intestines and gallbladder guidance should be used together; even with residual toxin, peace comes after stool.

Stool should always be moist; once every one to two days is best. If constipation after scabbing, due to excessive smallpox eruption, blood dryness and Qi failing to moisten intestines, use Runchang Wan (Moisten Intestine Pill) combined with Gandao Method (Gallbladder Suppository Method) (see previous).

Pores open, sweat pours like rain; Wei Qi and Ying Blood weak, both indifferent. Jianzhong self-sweat decoction prevails; night sweats归于 Huangliu Ping (Six-Yellow Calm).

The Classics say: Wei Qi warms muscles, fills skin/hair, thickens pores, controls opening/closing. After smallpox, Wei Qi is injured, so after scabbing, weak Wei Qi causes sweating. Sweating while awake is Zihan (Spontaneous Sweat), use Jianzhong Tang (Establish the Middle Decoction); sweating while asleep is Daohan (Night Sweat), use Danggui Liuhuang Tang (Angelica Six-Yellow Decoction).

Blood within the body is originally peaceful; fire evil forces blood to violate channels. Fine flow from nose is treatable; flow from urine/feces, life does not stop.

After smallpox scabbing, sudden blood syndromes are highly critical. Nasal blood comes from Lungs, hematemesis from Stomach, hematuria from Small Intestine, hematochezia from Large Intestine; all due to toxins entering internally, forcing blood to run wildly. Urgently use Liangxue Dihuang Tang (Cool Blood Rehmannia Decoction) to stop it. If bleeding continues after medication, it is untreatable.

Suddenly vomiting roundworms, the syndrome is not [cold]; know internal heat and constant hunger. Only smelling food odor causes worms to emerge; vomiting and irritability, worms act tyrannically.

Cold Damage vomiting roundworms blames Stomach Cold; Smallpox vomiting roundworms blames Interior Heat. Due to heat-toxin stifled internally, inability to eat, worms lack nourishment, emerging upon smelling food odor; use Huanglian Zhihui Tang (Coptis Stop Worm Decoction).

Blazing Stomach fire forms Gan erosion; frequent acrid-hot meals intensify Yang toxicity. Gums rotten/smelly, fear cheek perforation; medicine has divine merit, do not discuss value.

After smallpox, gum ulcers with frequent bleeding are called Yaxuan (Gum Bleeding); foul breath is called Xilu (Breath Leak). This is Zouma Gan (Running Horse Gangrene). Due to heat in Yangming and Shaoyang meridians, internally administer Xixin San (Washing Heart Powder), externally apply Cantui San (Silkworm Cast-off Powder).

Sores on tongue, red ones called Chikou Chuang (Red Mouth Ulcer), heat in Heart and Spleen meridians; internally administer Xixin San, externally apply Yinyang San (Yin-Yang Powder); white sores named Baikou Chuang (White Mouth Ulcer) or Ekuo Chuang (Goose Mouth Ulcer), heat in Heart and Lung meridians; also take Xixin San, externally apply Zhufan San (Cinnabar Alum Powder).

Why do food/drink not build flesh? Mostly due to dual deficiency of Qi and Blood. Peaceful pills/powders should be taken regularly; leaning hot or cold increases deviation.

Children usually fleshy, emaciated after smallpox, though able to eat, do not build flesh, due to Qi and Blood deficiency. Treatment must combine Yin and Yang, not lean to one side; leaning Yang injures Blood, leaning Yin injures Qi, increasing deviation. On Yin days, take Shenling Baizhu San (Ginseng Atractylodes Poria White Atractylodes Powder); on Yang days, take Danggui Yirong Wan (Angelica Enrich Glory Pill).

Post-smallpox skin and flesh are delicate; protect diligently in dusk/morning. Avoid Wind-Cold-Summerheat-Dampness; bathing/rubbing/grasping disasters are not forgiven. Post-smallpox middle deficiency, food easily injured; acrid-aromatic/raw-cold do not lightly taste. If greedy for mouth/belly without taboo, violating harmony turns into internal injury.

These two lines discuss post-scabbing regulation methods. Externally, skin is thin/tender, prone to colds; if not avoiding Wind-Cold-Summerheat-Dampness, combing/bathing/lifting, carbuncles may arise, sores/scabies may grow. Internally, intestines/stomach are weak, hard to digest; if not distinguishing raw/cooked, soft/hard, cold/hot, eating arbitrarily, distension/fullness may result, or diarrhea/dysentery may occur. Can one not be cautious!