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(Additionally, the concept of "Dou Mu" [Placental-like Ductule/Toxic Nodule] has been discussed in the preceding section regarding abnormal smallpox morphologies and syndromes.)

When smallpox triggers carbuncles or toxic swellings, it is also referred to as "Dou Mu". The *Classic of Internal Medicine* states: If Dou Mu appears before the eruption of smallpox, the prognosis is ominous; if it appears after the eruption, the prognosis is half auspicious and half ominous. This is mostly because the toxic pathogen fails to vent outward, inevitably accumulating to form carbuncles and sores, thereby obstructing the meridians and collaterals. However, this stagnation and accumulation itself is not yet a matter for grave concern; what is truly worrisome is its inability to dissipate, as well as improper treatment methods. Therefore, the method of dissipation must grasp the key principle, which lies in distinguishing between deficiency (Xu) and excess (Shi). For instance, in cases of severe toxicity in smallpox carbuncles, detoxification is indispensable; in cases of intense heat, clearing fire is indispensable. Once the fire-toxin is slightly cleared, one should then regulate the Spleen Qi. In cases where there is apparent heat on the exterior but underlying insufficiency of Yuan Qi (Primal Qi), one should exclusively employ the supporting method (Tuo Fa), ensuring that Yuan Qi remains intact and dietary intake does not diminish. In such scenarios, the toxin will naturally transform, posing no harm. However, if one fails to examine the strength of the root constitution and only knows how to attack toxins and clear fire, the Spleen and Stomach will invariably be damaged. This often leads to a daily decrease in dietary intake, a daily depletion of Ying Qi (Nutritive Qi), failure to transform pus and blood, progressive internal sinking of the toxin, and consequently, a hundred variations of smallpox complications. Thus, from beginning to end of smallpox treatment, priority must always be given to protecting Spleen Qi. Without understanding this, there are no cases where smallpox can be preserved when the Middle Qi (Zhong Qi) is deficient and failing.

1. When a smallpox carbuncle first arises, presenting with fullness, swelling, and severe pain, but without damage to Yuan Qi and with normal dietary intake, it is appropriate to initially use Lianqiao Guiwei Decoction (Forsythia and Angelica Caudata Decoction) or Xianfang Huoming Yin (Immortal Formula for Preserving Life) to resolve the toxin. Once the toxic qi subsides slightly, one should then use Sijunzi Tang (Four Gentlemen Decoction) combined with Danggui (Angelica Sinensis) and similar herbs to tonify and support Yuan Qi.

2. Whenever using formulas for supporting the interior, if there is no severe internal heat in the carbuncle/toxin, nor symptoms such as constipation, irritability, or thirst, or if the patient’s constitution is inherently weak, or if the Yin toxin has sunk deeply presenting with non-protruding lesions, lack of redness and swelling, absence of suppuration, and mild pain, the toxin resides internally. In all these cases, it is urgent to use interior-supporting herbs. One may use Liuqi Jian (Six Qi Decoction) added with Jinyinhua (Honeysuckle), Gancao Jie (Licorice Joint), Fangfeng (Saposhnikovia), Jingjie (Schizonepeta), Baizhi (Angelica Dahurica), Chuanshanjia (Pangolin Scale), and Niubangzi (Arctium Seed). If Yang Qi is insufficient, Rougui (Cinnamon Bark) and Fuzi (Aconite) may still be added. The decoction may be prepared with half wine and half water, or entirely with wine. Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) may also be used酌情ly.

3. In cases of internal heat, afternoon fever, and lack of appetite, this mostly belongs to Spleen and Stomach insufficiency and Qi-Blood weakness. It is appropriate to use Liuqi Jian or Wenwei Yin (Stomach-Warming Decoction), added with Jinyinhua and Baizhi. If the carbuncle/toxin is white in color and itchy, it indicates Qi deficiency; the treatment is the same as above. If the base is red and itchy, it indicates Blood deficiency with Blood heat; it is appropriate to use Siwu Tang (Four Substances Decoction) added with Danpi (Moutan Cortex) and Baizhi. If swollen but un-ulcerated, it indicates Qi-Blood deficiency; Tuoli Xiaodu San or Tuoli Xiaodu San added with Rougui may be used. If ulcerated but unable to heal/converge, it indicates Spleen Qi deficiency; Liuqi Jian or Liuwu Jian (Six Things Decoction) added with Rougui is appropriate.

4. In cases where dietary intake is normal but both interior and exterior present heat, accompanied by carbuncle/toxin swelling and pain, or irritability and thirst, or hot and stagnant urination and defecation, Dalianqiao Yin (Large Forsythia Decoction) or Xianfang Huoming Yin may be used alternately. If dietary intake is normal, internal heat causes pain, or is accompanied by mouth and tongue ulcers, Shegan Niuziangzi Tang (Belamcanda and Arctium Seed Decoction) may be used alternately.

5. When smallpox toxin causes carbuncles characterized by hard nodules and difficult-to-resolve Excess Heat, Paidu San (Toxin-Expelling Powder) is appropriate.

6. Carbuncles and furuncles appearing after smallpox are caused by residual toxin from the smallpox remaining in the meridians, limbs, and joints, forming swellings. Detoxification or clearing fire may be applied according to suitability. For those wishing to resolve both exterior and interior simultaneously, Chaihu Maidong San (Bupleurum and Ophiopogon Powder) is appropriate. For those wishing to moisten the intestines and resolve toxin, Xiaodu San (Detoxifying Powder) and Sixun Qingliang Yin (Six-Harmonies Cooling Decoction) are appropriate. For those wishing to cool the Blood and resolve toxin, Xi Yu Dihuang Tang (Rhinoceros Horn, Catfish, and Rehmannia Decoction) is appropriate. For those wishing to clear fire, promote urination, and resolve toxin, Dalianqiao Yin is appropriate.