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Wan Quan pointed out: "Dou Lai" (smallpox-derived leprosy-like condition) is caused by heat-toxin stagnation and obstruction, deficiency of Qi and Blood, leading to the decay of muscles. The *Neijing* states: "When heat prevails, flesh rots," which refers to this situation. The *Zheng Lilun* states: "A pulse that is floating and large; floating indicates wind and deficiency, while large indicates strong Qi. When wind and Qi contend with each other, urticaria (skin redness, swelling, and itching rashes) must form, causing body itching. This type of itching is named 'Xie Feng' (draining wind). Over time, it develops into severe leprosy." Individuals with sufficient Qi and Blood are free from external deficient wind and internal strong pathogens, so they will certainly not contract this disease. Only those who have a constitutional deficiency of Qi and Blood cannot allow Ying-Wei (Defensive and Nutritive Qi) to nourish the body, making them susceptible to the killing energy of heaven and earth. Deficient wind resides within the skin and flesh, compounded by the filth-toxin of smallpox/rash and the malignant qi of epidemics. These factors strike, scorch, and burn, spreading widely and exiting through the pores. Consequently, the sores are originally dense, leaving no intact skin on the body, with unbearable itching, muscle ulceration, thus forming Dou Lai. At this point, one must urgently employ methods to greatly tonify Qi and Blood and clear heat-toxins to seek preservation of life. If one waits until the face decays and falls off, the nose collapses, lips rupture, eyes go blind, and limbs are maimed, even if death does not occur, the person will become disabled.

For cases where sores break and transform into leprosy-like conditions, use Shiquan Dabu Tang (Decoction for Ten Thousand Benefits, used in the sweating stage) combined with Kushen Wan (Pill of Sophora Root), taken together. Externally, apply Miecan Jiuku San (Powder to Eliminate Scars and Save from Suffering, used in the crusting stage).

Kushen Wan Formula: Kushen (Sophorae Flavescentis Radix, 1 liang), Baijili (Tribuli Fructus), Huma (Sesami Fructus), Niubangzi (Arctii Fructus) (each 0.5 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian 5 fen).
Grind all ingredients into powder. Mix with wine and flour to form pills. Take with Zhuye Decoction (Bamboo Leaf Decoction).

The classic states: "Heat prevailing causes swelling." Generally speaking, abundant toxins cause swelling, while mild toxins do not. When all sores have erupted and begin to develop according to schedule, if the head and face gradually swell, this indicates that heat-fire toxin is dispersing and gathering in the three Yang meridians, preparing to suppurate and form blood, hence the swelling of skin and flesh. However, if at the time when development should occur, the head and face do not swell, it means the base of the sores is distinct and prominent, and the toxin is light and superficial. Although suppuration may occur, the base does not occupy a large area, so there is no swelling; this requires no treatment. If the base of the sores is indistinct and blurry, and there is no swelling during development, this indicates the toxin is hidden internally and has not yet been vented; one cannot conclude that the toxin is mild.

If during development there is swelling, but the skin and flesh appear normal, with round and sharp sore tips and clearly defined grains, this is a favorable omen. If the skin color is bright red, the bases of the sores are connected in clusters, sticky and flat, or if the sore color is grayish-white like a cake with a surface resembling tin foil, or if the sores are scorched, purple, and dry without fluid, these are all ominous omens.

If the head and face swell prematurely before development, this is due to the concurrent presence of epidemic toxin, known as Datou Wen (Big Head Plague). If the cheeks and jaw swell prematurely, this is known as Xia Ma Wen (Toad Plague); it must be treated concurrently with epidemic measures, and the prognosis is mostly poor with little hope of recovery.

Generally, for swollen sores, until the stage of drying pus and forming scabs, the toxin transforms and the swelling subsides. Therefore, situations where swelling should occur but does not, or where swelling should subside but does not, require careful vigilance.

For cases of sore swelling with facial edema and closed eyes, urgently employ combined treatments of detoxification, eye protection, and throat rescue. Internally, use Xiaodu Huaban Tang (Decoction for Detoxification and Spot Resolution, used in the development stage); externally, apply Shenyin Gao (Miraculous Ointment, seen in the eruption stage) to protect the eyes.

For swollen sores, one must strictly prevent itching. There must be no damage to the center of the face. If scratching causes breaks, the momentum of sand-cracking becomes irreversible, pathogenic qi sinks inward, true qi leaks outward, and death occurs as swelling subsides. However, if broken areas can be refilled with pus, subsided areas can re-swell, diet remains normal, and bowel/bladder functions are naturally regulated, the ominous turns auspicious. Use Shiquan Dabu Tang (used in the sweating stage) and Kushen Wan (used for Dou Lai) combined for treatment.

If the sore color is grayish-white and the face swells like a tin cake, observe the patient's zang-fu organs. If they can eat, stools are regular, urine is long and clear, and there are no other sufferings, the prognosis is mostly good. If they cannot eat, vomiting and diarrhea occur simultaneously, or itching arises, the prognosis is mostly bad.

If the head and face swell prematurely, or the cheeks and jaw swell prematurely, this is due to seasonal epidemic toxins. Treat all such cases primarily with Qianghuo Jiuku Tang (Notopterygii Rhizoma et Radix Decoction for Saving from Suffering).

Qianghuo Jiuku Tang (See Development Stage)