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In cases where a patient falls into sudden lethargy or coma before the smallpox rash has fully erupted, the condition is severe. One must examine the pulse and symptoms to differentiate between deficiency and excess, and intervene preemptively. If drowsiness occurs after the eruption of the rash, it indicates that the pathogenic factors (toxins) have been resolved and the primordial Qi (vital energy) is recovering; thus, the evil qi has retreated and the spirit is at peace. This is a sign of transition from adversity to prosperity, and no medication is required. However, if signs of quietude and Qi deficiency are observed, formulas such as *Tianyuan Decoction* (Regenerate Origin Decoction), *Baoyuan Decoction* (Protect Primordial Decoction), or *Liuyue Decoction* (Six Ingredients Decoction) should be used. Based on the presence of cold or heat, gradual regulation will lead to natural recovery. One must not recklessly use drugs that consume and weaken the body, as this would damage the spirit and cause harm.

The Classics state: "The loins are the mansion of the Kidneys." It also states: "Manifestations of the Taiyang (Greater Yang) channel can result in lumbar pain." The Foot-Taiyang Bladder meridian runs alongside the spine and connects with the Kidneys. The toxins of smallpox often originate from the Kidneys and spread through the various meridians via the Foot-Taiyang Bladder channel, representing the transmission of pathogenic factors from the interior to the exterior. If fever and lumbar pain appear simultaneously at the onset, or if the pain worsens progressively day by day, this indicates that the pathogen has entered directly from the Bladder into the Kidneys, preventing the toxin from being expelled. Urgent detoxification is required to drain the Shaoyin (Lesser Yin) kidney pathogen and unblock the Taiyang bladder meridian, ensuring the pathogen does not penetrate deeper. Even if the rash is dense, recovery is possible. If treatment is not prompt, the pathogen will sink deeper daily, exacerbating both exterior and interior conditions. The circulation of Ying (Nutritive) and Wei (Defensive) vessels will cease, and the Qi of the Zang-Fu organs will fail. This may lead to itching and ulceration, or black depression (dark, sunken lesions), which ultimately becomes incurable.

First: Generally, when smallpox toxins transmit from Yin channels to Yang channels, or from the interior to the exterior, it is considered a favorable progression (Shun). Transmission from upper to lower, or from exterior to interior, is unfavorable (Ni). If the toxin transmits from the Taiyang channel to the Shaoyin channel, the toxin sinks and fails to ascend, hiding within the bone marrow and unable to reach the exterior, resulting in lumbar pain. In general, if the toxins of sores and rashes converge into the Kidneys, death ensues. Therefore, upon observing lumbar pain, urgent treatment is necessary. If the toxin is sunken and cannot rise, dispersing and detoxifying methods should be employed to force it back out through the Taiyang channel and into the Yang pathways, thereby avoiding harm. *Renshen Baidu San* (Ginseng Rescue Powder) or *Wuji San* (Five Accumulations Powder) are appropriate. If Kidney Qi is deficient and unable to transport the toxin outward, *Liyin Jian* (Yin-Regulating Decoction) added with *Xixin* (Asarum), *Guigui* (Cinnamon Twig), *Duzhong* (Eucommia Bark), and *Duohuo* (Angelica Pubescens) should be used.

Second: For cases where lumbar pain appears concurrently with fever, applying warm Sesame Oil (Sesamum indicum) to the painful area and massaging it can alleviate the pain. Simultaneously, the aforementioned medications should be taken urgently. If urination is difficult, *Wuling San* (Five-Ingredient Powder with Poria) is suitable. If internal fire-toxin is abundant causing difficulty in urination, *Siling San* (Four-Ingredient Powder with Poria) added with *Zhizi* (Gardenia Fruit) and *Mutong* (Akebia Caulis) is indicated.