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Fu (entrapment) refers to the pathogenic toxin accumulating internally without being able to erupt. Xian (sinking) refers to the toxin having erupted but subsequently sinking back into the body. Both are ominous signs. Fu presents as a single syndrome, whereas Xian has several variations. The signs of Fu appear when the rash manifests; the patient develops lesions, yet the fever does not significantly subside, accompanied by irritability, thirst, chest stuffiness, and restlessness. This indicates that the toxic heat has not been fully expelled. Xian occurs after the rash has manifested; if the blood within the lesions gradually dries up and turns black, it is called "Black Sinking" (Hei Xian). If the pustular fluid fails to form before rupturing, causing itching and collapse, it is called "Reverse Sinking" (Dao Xian). If pus forms but reverts to water-like fluid and refuses to scab over, it is called "Reverse Crusting" (Dao Ye), which also falls under the category of sinking syndromes. Any lesion turning black is termed Black Sinking. Rashes turning black are generally considered incurable because the Kidney corresponds to Water, and its associated color is black; this represents the appearance of the true organ color of the Kidney. Incompetent physicians fail to understand the principle of "black turning归属于 the Kidney." They erroneously believe that the Kidney should not be tonified (filled) and attempt to drain the Kidney to induce deficiency. They do not realize that the human body, in broad terms, is governed by Yin and Yang, and in specific terms, by the Heart and Kidney—what practitioners refer to as True Water and True Fire. The fire-toxin of the chickenpox/smallpox erupts from within, relying on this trace of True Water to restrain excessive fire. If one attempts to drain this True Water, the fire loses its restraint, and the root foundation is shaken; this is certainly not the key to treatment. However, saying the toxin "returns to the Kidney" is because the Kidney governs bone marrow and closure/storage. The filth and toxin of the rash travel from the bone marrow to the muscles, skin, and hair, moving from inside out so that the toxin can be vented. Now, having sunk and become entrapped, the toxin moves from outside back inside, hiding in the bone marrow; thus, it is called "returning to the Kidney."

Furthermore, when the rash first appears, it coincides with the Spring season's command of growth and emergence. If the lesions turn black upon emergence, it is like Winter's command operating in Spring. When the rash rises and swells, it coincides with Summer's command of nourishment and development. If it turns black upon rising, it is like Winter's command operating in Summer. During the stage of maturing the pustules, it coincides with Autumn's command of ripening and solidification. If the dried pus turns black, it is like Winter's command operating in Autumn. Therefore, all these are termed "Rebellious" (Ni) patterns. At the stage of scabbing, it coincides with Winter's command of closure and storage; this is the normal sign of the Kidney. If no scab forms and pus infiltrates, it is like Spring/Summer commands operating in Winter, also termed Rebellious. Only those who understand the mechanisms of natural creation can discuss the theory of "returning to the Kidney." Colors that are black result from Fire transformation; observing objects burned dry reveals they turn black, and things emerging from fire are also black—how can these be said to belong to Water? The Classic states: "When Fire erupts, it causes obscuration and dimness." Understanding this allows one to discuss Black Sinking.

For cases where the toxin is entrapped and cannot erupt, Shuangjie San (Double Resolution Decoction) is the primary formula (for the initial heat stage). If the spots are white or black, the patient will likely refuse milk, suffer from spontaneous diarrhea, vomiting, or cold limbs. This is due to Stomach Qi deficiency failing to support Ying and Wei circulation. It is appropriate to use warming formulas for the Middle Jiao to warm the Stomach, allowing Ying and Wei to resume circulation, after which the rash will naturally erupt. Suitable formulas include Lizhong Tang (Regulate the Middle Decoction, for vomiting/diarrhea in smallpox) and Dingxiang Zhusan (Clove Boiled Powder, for vomiting/reversal in smallpox). For Reverse Sinking, examine the bowels. If there is constipation of both urine and stool, Sixun Qingliang Yin (Four-Obedience Cooling Drink) combined with Duoming Dan (Life-Restoring Pill) is indicated. If there is diarrhea with weak Qi, Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) combined with Duoming Dan is indicated. Externally, apply Huyijiu (Coriander Wine) and Shuiyangtang (Water Poplar Decoction) (both for the eruption stage). Mr. Danxi stated: Reverse sinking of smallpox is caused by deficiency of True Qi preventing complete expulsion of toxins; treat with Huangqi (Astragali Radix), Renshen (Ginseng Radix), and Zicao (Arnebiae Radix et Rhizoma processed with wine). If the lesions appear pale just before completion, it belongs to Blood deficiency; use Danggui (Angelicae Sinensis Radix) and Chuanxiong (Ligustici Chuanxiong Rhizoma), possibly adding Honghua (Carthami Flos) and Zicao. If it belongs to Heat-Toxin, use Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), Jiegeng (Platycodonis Radix), and Qiaoyu (Forsythiae Fructus). For severe cases, use Xijiaoxie (Rhinocerotis Cornu Fragment) to strongly resolve the smallpox toxin. [Xue Ji] privately opines that regarding the aforementioned conditions: if Heat-Toxin is just erupting but suddenly blocked by Wind-Cold closing the muscle pores, causing blood stasis, body pain, slight cold limbs, failure of spots to grow, or turning cyanotic/purple/black, this is Dao Ye (Reverse Crusting). If Stomach Qi is weak and cannot supplement Ying and Wei, causing the rash to emerge and then disappear, this is called Xian Fu (Sinking Entrapment). Misusing detoxifying herbs will inevitably lead to collapse. If the patient prefers hot drinks and has cold hands and feet, it is a syndrome of Spleen-Stomach damage with Yang Qi deficiency and Cold; treat with acrid-hot tonifying agents. If the patient prefers cold drinks and has hot hands and feet, it is a syndrome of excess Heat in Yang Qi; treat with bitter-cold draining agents. For external Wind-Cold, use warming dispersants. For toxin entering the abdomen, use separating and draining methods. For Yang Qi deficiency, use warming tonics. For external Cold invasion, use fumigation and resolution. Since ancient times, it has been said that White Sinking is incurable. Generally, white spots will turn gray and miserable; gray and miserable spots will eventually flatten and collapse, hence called White Sinking. This is indeed caused by Qi deficiency, but since Blood fails to provide luster, Blood is also fundamentally deficient. Treatment must address both Qi and Blood. When Blood circulates and Qi moves, white can turn red, preventing sinking and collapse. If only Qi is tonified, Qi becomes excessively dry and hot, inevitably leading to sinking. Thus, if white spots are scratched open, becoming thin-skinned, dry, and extremely itchy, it is due to neglecting Blood tonification, resulting in extreme Qi excess and dryness. Using more Qi-tonifying herbs is a sign of imminent death. Therefore, whenever white spots are seen, regardless of timing, treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Siwu Tang (Four Substances Decoction). If there is internal heat, add detoxifying herbs or promote urination. If one waits until White Sinking is established before treating, it is difficult to effect a cure. Smallpox presents with Purple-Black Sinking and Gray-White Sinking. Purple-Black Sinking is due to Blood Heat causing dryness and stagnation, with Qi unable to circulate; this is an Excess pattern. If treated urgently, survival is likely. Gray-White Sinking is due to collapse of Yuan Qi, preventing eruption and blood penetration; this is a Deficiency pattern, and rescue is often difficult.

If the rash is about to erupt but contains fluid that is dark black, treat with Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) mixed with Wuji San (Priceless Powder), or administer Kuaiban Tang (Rapid Eruption Decoction) and Duoming Dan together.

For Reverse Crusting, again examine the bowels. If constipated, use purgatives such as Sanhuang Wan (Three Yellows Pill) or Sixun Qingliang Yin (for fever). If diarrheic, use tonics: mild cases with Shiquan Dabu Tang, severe cases with Chen's Muxiang San (Chen's Costus Powder), externally applying Baicao San (Decayed Grass Powder).

[Pang Anchang] Yujin San (Curcuma Powder): For smallpox starting with white blisters, suddenly convulsing into the abdomen, gradually turning purple-black, lacking pus, with day-and-night crying and agitation.
Yujin (Curcumae Radix, 1 piece)
Gancao (Licorice Root, 1 fen)
Boil in half a bowl of water until dry. Remove Gancao, slice, bake dry, and grind to fine powder. Add Naozi (Borneolum Syntheticum, half qian), mix well. Take 1 qianbi per dose, mixed with 5-7 drops of fresh pig blood, administered with fresh well-water. Within two doses, severe cases will expel toxin from the palms and soles resembling carbuncles, indicating recovery. This is a critical prognosis (five deaths, one life).

Sixiang San (Four Sages Powder): For Black Sinking, Reverse Crusting, failure to erupt, lack of redness/vitality, and difficulty urinating.
Zicao (Arnebiae Radix et Rhizoma)
Huangqi (Astragali Radix)
Gancao (Licorice Root)
Mutong (Akebiae Caulis)
Decoct in water and drink. If heat is severe and color is purple, double Zicao, add Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), and Honghua (Carthami Flos). If constipated, add Zhike (Aurantii Fructus). If normal, add Nuomi (Oryza Sativa Glutinosa).

Shenling Neituo San (Ginseng and Atractylodes Internal Support Powder) (See Itching/Collapse section)
Wuji San (Priceless Powder)
Use human, cat, pig, and dog feces, burned to ash in the twelfth lunar month. Mix with rock sugar water and take.

Nanjin San: Treats smallpox that has erupted but receded, a critical condition unresponsive to other drugs, ensuring safety.
Zibei Heye (Purple-backed Lotus Leaf, harvested after frost with purple backs)
Baijiangcan (Bombyx Batryticatus, washed free of silk, stir-fried dry)
Grind to powder. Equal parts. Dosage depends on age: adults 1 qian, children 0.5 qian. Grind with Yuanxi juice (Coriander juice) and wine, or rice water.
Treating this condition often involves Longnao (Borneolum) and Renya (Human Teeth), which are hard to obtain. This formula is non-toxic and fast-acting. Purple-backed leaves are rare; check salt shops.

Ganlan Yin (Olive Drink): Treats Reverse Crusting.
Cut olive in half. Take a small amount boiled in water. It promotes immediate eruption.

Baihuashe San (White-Banded Snake Powder): Treats smallpox/rash Black Sinking and Reverse Crusting.
Baihuashe (Bungarus multicinctus, including bones, 1 liang, fire-dried but not charred)
Dingxiang (Caryophylli Flos, 20 pieces)
Grind to powder. Take 0.5 qian or 0.2 qian, washed down with hot wine. If Black Sinking, the color turns red after a while; very effective.

*Luofu Fang* treats collapsed smallpox. Verse:
"Wushe (Black Snake), Quanxie (Scorpion), and Jiangcan (Silkworm),
Along with Shanjiarou (Pangolin Scales with meat) and Chan (Mantis Egg-case).
Each of these four pure ingredients weighs one liang,
Add twice as much Guanrou (Cinnamomi Cortex).
Boil in strong white wine and take as desired.
Many collapsed smallpox cases are restored to wholeness."
I have used this frequently, saving many lives. Note: Jiangcan must be free of silk, washed clean of lime, and sun-dried. Wushe must use the excellent tail portion. Shanjiarou must be washed in wine and baked dry.

[Yuan Shi] Treating Reverse Crusting. Verse:
"Reverse crusting is difficult post-smallpox,
Due to mutual depletion of Qi and Blood.
Renshen (Ginseng), Huangqi (Astragalus), Danggui (Angelica), Dihuang (Rehmannia), and Chantui (Cicada Slough)
Taken continuously, the crusts will return naturally."
Another verse:
"If bleeding persists from reverse crusting, it is named 'Returning Yang Spring.'
If it affects the chest and flanks, nine out of ten die.
Quickly find Yanzhipei (Red Earth/Pigment), add one qian of Xuemei (Dragon's Blood).
Burn them retaining their nature, apply to stop bleeding and dry the wound."
I have seen many wrongly use bathing methods for post-smallpox reverse crusting, causing unnecessary deaths. If scabs are thick and cannot detach, or detach partially leaving central piercing pain, or detach around the edges but leave the center, use the following formula:
Shengmi (Raw Honey)
Suheyou (Styrax Oil)
Mix evenly. Apply along the edge of the scab base using a silver hairpin. Pain stops immediately, and the scab detaches quickly without risk of hemorrhage or flesh tearing. If Suheyou is unavailable, substitute with Chicken Oil (from a hen fed thread/wire?), which is also excellent.