Library

When the pustules of smallpox are ripe or only slightly ulcerated, this is also a common occurrence. However, when ulceration occurs before the pus has formed, it is named "Banlan" (macular ulceration); when the scabs should have formed but do not, and the body remains extensively broken and unhealed, it is named "Kuilan" (ulceration). This is largely due to failing to apply dispersing methods when indicated prior to eruption, causing heat-toxin to be retained internally, which inevitably leads to ulceration accompanied by panting, shortness of breath, chest oppression, and restlessness. Alternatively, if dispersing methods are mistakenly applied when they are not indicated, it causes deficiency at the exterior and rampant toxin, leading to widespread ulceration. These are all consequences of improper use of exterior-releasing treatments. Furthermore, if yang-toxin blazes internally with excessive fire and a solid pulse, constipation, and a preference for cold drinks, yet clearing and draining measures are neglected, heat accumulates in the Yangming channel, resulting in muscle ulceration; this is due to improper detoxification. Therefore, in treating such cases, for those with exterior heat, one should still clear and regulate the fire pathogen; for those with exterior deficiency, one should tonify and nourish Ying and Wei (nutritive and defensive qi). Since the Spleen governs the muscles, it is especially important to regulate the Spleen and promote appetite, ensuring smooth bowel movements to facilitate tissue regeneration and detoxification. Detoxification should not be excessively cold, and nourishment should not be excessively hot; achieving a state of balance is the best method.

1. For those with exterior deficiency unable to consolidate, there is invariably an insufficiency of Wei Qi without other heat signs. It is appropriate to use formulas such as Shiquan Dabu Tang (Complete Ten Tonifying Decoction), or remove Rougui (Cinnamon Bark) and add Fangfeng (Saposhnikovia Root) and Jingjie Sui (Schizonepeta Spike), taken frequently until self-healing occurs.

2. For ulceration caused by excessive fire and stomach heat, Dalianqiao Yin (Great Lonicera Decoction) is appropriate; if severe constipation is present, pig bile can be used for enema administration.

3. If excessive exterior-releasing or over-clearing leads to deficiency in both interior and exterior, with Yang Qi failing to secure itself, internal diarrhea and external ulceration may result. Urgent treatment of the interior is required, using Chen's Shi'erwei Yigong San (Twelve-Ingredient Extraordinary Merit Powder) or Jiawei Yigong Jian (Nine-Ingredient Extraordinary Merit Decoction).

4. For ulcerations with dripping purulent discharge, Baicao San (Decayed Grass Powder) or Qiaomai San (Buckwheat Powder) can be applied as dressings. For painful macular ulceration suppurating heavily, Tianshui San (Tianshui Powder) mixed with Baihua Gao (Hundred Flowers Ointment) should be applied externally.

5. If a smallpox patient wears thick cotton clothes, wraps themselves in heavy quilts, seeks warmth near fire, or consumes alcohol freely, and scabs form prematurely before seven days have passed, causing rapid closure despite insufficient time, leading to flat ulceration from the face to the waist without scabbing, this is not normal scabbing but "Dao Ye" (reversed scabbing). One should urgently remove clothing and bedding, avoid fire, and abstain from alcohol. A formula was established for this: Huangqi (Astragalus Root) and Baizhi (Angelica Dahurica Root) to drain pus; Fangfeng (Saposhnikovia Root) and Chantui (Cicada Slough) to disperse the exterior; Qingpi (Green Tangerine Peel) and Jiegeng (Platycodon Root) to harmonize the middle; Niubangzi (Arctium Fruit) and Gancao (Licorice Root) to detoxify. After ingestion, if the ulcers swell again, it indicates that internal and external toxins are being expelled without retention, allowing gradual healing.