Library

If smallpox lesions can follow the disease stage to properly fill with pus and form scabs, appearing round and raised like a snail shell (luoye), it is an auspicious sign. If the pus has not yet fully accumulated but suddenly dries and forms scabs; or if after pus formation, no scabs form and the lesions instead become broken; or if during the scabbing-off stage, diarrhea with pus and blood occurs; or if the vesicles become empty and dry up; or if fever and delirium occur; or if teeth are chattered and shivering happens; or if both hands and feet become cold, such that even drinking boiling water feels no heat, this is called "reversed scabbing" (daoye). This is due to insufficient middle qi, causing the pathogenic toxin to enter from within. It is appropriate to select Shennei Tuosan (Ginseng Internal Support Powder), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), or Baoyuan Tang (Preserve the Origin Decoction) for treatment, so that broken lesions may refill with pus again, and no additional accessory pustules (zengdou) will emerge. In this way, the healthy qi is replenished, enabling the expulsion of pathogenic toxins once more. If, after taking tonifying medicines, no accessory pustules appear, the broken areas do not swell and refill with pus, but instead continue to discharge pus and blood, the condition is incurable. If, just as scabbing is about to complete, the lesions suddenly turn black; or if the scabs form prematurely before the pus is full; or if although the pus is full, they all dry up and turn purple, this indicates qi deficiency and blood heat, caused by fire pathogen forcing premature contraction. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Zicao Rong (Saussurea Root) or Sisheng San (Four Holy Powders) added with Renshen (Ginseng) and Danggui (Angelica Sinensis) may be used. However, the specific manifestations must be further deduced and differentiated. For instance, if there is body pain, slight coldness in the four limbs, and green-purple lesion color, this is due to external cold pathogen invading, closing the interstices and rejecting the pathogen, leading to reversed scabbing. Ren Shen Bai Du San (Ginseng and Detoxification Powder) should be used, along with spraying Huixie Jiu (Coriander Wine) on the affected areas. If reversed scabbing occurs suddenly accompanied by mental restlessness, Zhuwei Gao (Pig Tail Ointment) is indicated. If there is mental agitation, mania, delirious speech, constipation, thirst with desire to drink, and ability to eat, this is due to external contact with foul turbid qi causing reversed scabbing. Neifu Deming Dan (Internal Administration of Life-Snatching Pill) should be taken, while Wai Shao Xunhui San (External Burning of Foul-Expelling Powder) should be burned externally to ward off the foul qi. If reversed scabbing is triggered by corpse qi, Bihui Xiangjie (Foul-Qi Warding Incantation/Powder) should be used. If the pus is not yet full but the eye sockets suddenly sink deeply, this is qi collapse causing involution; if accompanied by lethargy and phlegm-wheezing, death ensues. Zhu Danxi stated: Smallpox reversed scabbing occurs because true yang is deficient, preventing the toxic vapors from being expelled. Baoyuan Tang (Preserve the Origin Decoction) added with Zicao (Saussurea) and similar herbs is suitable. If at the stage of nearing maturity, the color remains pale, this belongs to blood deficiency, treated with Xiong (Ligusticum Chuanxiong) and Gui (Angelica Sinensis). Red Flower (Honghua) and Zicao (Saussurea) may be added. If it belongs to heat, Shengma (Cimicifuga), Qin (Scutellaria), Lian (Coptis), and Jiegeng (Platycodon) are used. Severe cases require Xijiao (Rhinoceros Horn). Xue Ji stated: If heat-toxin is just emerging but is suddenly blocked by wind-cold closing the muscle pores, causing blood vessels to stagnate, resulting in body pain, slight coldness in the four limbs, failure of spots to grow, or turning green-purple-black, this is called reversed scabbing. If stomach qi is weak and unable to nourish Ying and Wei, causing the rash to emerge and then vanish, it is called "sunken and hidden" (xianfu). Misusing detoxifying drugs will inevitably lead to collapse. If the patient prefers hot food and drinks and has cold hands and feet, this is a syndrome of spleen-stomach weakness, treated with acrid-hot agents to tonify. If the patient prefers cold food and drinks and has hot hands and feet, this is a syndrome of strong yang-heat, treated with bitter-cold agents to drain. External wind-cold is treated with warming and dispersing methods. Toxic vapors entering the abdomen are treated with draining and separating methods. Yang qi deficiency is treated with warming and tonifying methods. External cold invasion is treated with fumigation and resolving methods. Chen Wensu used Yigong San (Extraordinary Support Powder) to protect the spleen and stomach before they deteriorated, truly expounding upon what predecessors had not yet revealed, and enlightening generations to come.