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The base of the smallpox pustules is thin and inferior, the pus is turbid, stagnant, and lacks vitality. When it appears withered, yellow, and dull in color, it is called "Ban Huang" (Stiff Yellow). If only the forehead (Tian Ting) exhibits Ban Huang while the rest of the body remains moist and vital, the carbuncle toxin will likely accumulate in the brain and neck region. If the cheeks and face show Ban Huang while the four limbs remain moist and beautiful, the carbuncle toxin will likely erupt on the shoulders and upper back. If the abdomen shows Ban Huang, the toxin will likely erupt near the Quchi (LI11) and Zusanli (ST36) acupoints. If the spine shows Ban Huang, the toxin will likely accumulate in the flanks, sacrum, and coccyx. If the entire body exhibits Ban Huang, or if the neck (front and back), scalp, face, eye orbits, upper lip, flanks, and scrotum show Ban Huang, these are all fatal signs.

In my analysis, Ban Huang arises from heat in the stomach accompanied by excessive appetite, leading to food stagnation and accumulation in the middle jiao, thereby preventing the free flow of Stomach Qi. This is not the natural state of the root Qi of the smallpox itself. A practitioner who understands this principle should urgently administer bitter-cold herbs to resolve stagnation. For patients with constipation, mild purgation should be used. Once the heat and stagnation are cleared and the internal and external Qi mechanisms are unblocked, there will be no risk of carbuncle toxins.

Wen Ren Gui stated: When smallpox lesions are red, bowel movements are obstructed, urine resembles blood or contains blood, carbuncles form, or skin lesions rupture and bleed, this indicates excessive internal fire due to a failure in clearing and promoting free flow. Urgent treatment requires formulas such as Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), Xiaochaihu Tang (Minor Bupleurum Decoction) added with Sheng Dihuang (Rehmanniae Radix), or Sishun Yin (Four Smooth Infusion). Dr. Xue stated: If Heart and Spleen heat is severe, use Xijiao Dihuang Tang; if Heart and Liver heat is severe, use Xiaochaihu Tang added with Sheng Dihuang. If constipation is present, first use Sishun Yin, followed by Xijiao Dihuang Tang. If the lesions are red and painful with obstruction of both bowel and bladder, urgently use Miting Yin (Life-Saving Infusion) added with Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma). If the lesions are red and painful accompanied by aversion to cold and fever, use Miting Yin added with Mahuang (Ephedrae Herba). If caused by the nursing mother's anger, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).

Wen Ren Gui stated: The condition of smallpox erosion and ulceration occurs when dispersing methods should have been used but were not, causing toxic vapors to become blocked, leading to panting, distress, and confusion. Conversely, if dispersing methods are mistakenly applied when they are contraindicated, the toxin follows Yang Qi and violently erupts outward, causing widespread ulceration of the skin and flesh. Treatment should focus on regulating the Spleen and Stomach, promoting dietary intake, and harmonizing the bowels. When the Spleen and Stomach are robust, the toxic vapors will resolve naturally, preventing symptoms such as red eyes, sore throat, hematemesis, and epistaxis. If exterior-dispersing methods are overused, leading to spontaneous diarrhea, urgently use Lizhong Wan (Regulate the Middle Pill) or Doukou Wan (Cardamom Pill) to rescue the interior Yang. There are also cases where smallpox lesions resemble mosquito bites and the complexion turns black, which is a critical sign. If urination is obstructed with irritability, use Daochi San (Guide Out Redness Powder) added with Zhizi (Gardeniae Fructus), Xijiao (Rhinocerotis Cornu), and Chishao (Paeoniae Radix Rubra). However, if there is spontaneous diarrhea and anorexia, these cooling and blood-cooling formulas must not be used. This is because when the toxin is at the exterior, reckless sweating opens the pores, further depleting Ying and Wei Qi, thereby worsening the erosion. Consequently, Wind pathogens may invade due to deficiency, causing complications. If the toxin is retained internally and purgatives are recklessly administered, the internal Qi becomes further depleted, the toxin cannot exit, and instead sinks inward. This leads to Earth failing to control Water, causing the toxin to turn black and return to the Kidney. Symptoms include tremors and aversion to cold, cold ears and sacrum, closed eyes, abdominal distension, and blackened, sunken lesions. In such cases, fewer than one in ten survives. Physicians must exercise extreme caution.