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Nie Jiwu stated: From the fifth to sixth day after the eruption of smallpox, up to the eighth or ninth day, if the pus and plasma do not proceed normally, one should also use Shenguilurong Tang (Ginseng, Angelica, and Deer Antler Decoction) to support the body's qi and expel toxins. (Huang Sheng used this formula without modifications.) If the pus and plasma fail to rise at all, there is no hope for life. However, if there is four or five parts of pus, survival is still possible.

If the pus and plasma are insufficient, Jiguanjiu (Rooster Comb Wine) can also be used. Select a large rooster that has been raised for more than three years. First, warm a cup of good wine, then prick the comb to drip blood into the wine, mix well, and warm it again before administration. Some dryness and pain after taking the medicine is not a concern; the rooster should not be killed.

There is another type where the smallpox eruptions are dense, and the toxic fire is already intense, yet the primordial qi is deficient, and the blood and qi are weak. The body fluids are exhausted and cannot control the fire, leading to deficient fire flaming upward. Symptoms may include irritability or thirst, sore throat, or frequent nosebleeds. It is difficult to apply warming and tonifying methods in such cases, and the smallpox will likely fail to form pus and crusts. This condition is common in older males and females who have indulged in desires for a long time, depleting their blood and qi. It is extremely difficult to treat. Contemporary physicians, seeing many heat signs, typically use cooling formulas like Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), unaware that the cause is the inability of blood and qi to overcome the toxic pathogens. Using pure cold and cooling herbs now would further damage blood and qi, allowing the toxic pathogens to spread even more wildly. Is there any logic for survival in such cases? Therefore, among contemporary physicians treating these types of smallpox cases, ten out of ten die, which is truly pitiable. I have specially prepared Shenmai Qingbu Tang (Ginseng and Ophiopogon Clearing and Tonifying Decoction) to regulate this. (Ren Shen [Ginseng Root], Mai Dong [Ophiopogon Tuber], Tian Hua Fen [Trichosanthes Root], Sheng Huang Qi [Raw Astragalus Root], Qian Hu [Peucedani Radix], Niu Bang Zi [Arctii Fructus], Zhi Gan Cao [Prepared Licorice Root], Sheng Gan Cao [Raw Licorice Root], Chao Bai Shao [Stir-fried White Peony Root], Dang Gui [Angelica Sinensis Root], Hong Hua [Carthamus Flower], Da Chuan Xiong [Ligusticum Rhizome], Sheng Di Huang [Rehmannia Root], Jie Geng [Platycodon Root], Shan Zha Rou [Crataegus Flesh], Yuan Yan Rou [Longan Aril, three pieces]. Decoct together and take warm. Patients with this condition must take this medicine frequently.)

During the rising and suppurating stages, vomiting and diarrhea may occur, presenting different syndromes.

Vomiting has two aspects. Vomiting sour and bitter substances with sound, feeling relieved after vomiting, indicates toxic qi ascending. Use Zhilian Erchen Tang (Gardenia and Coptis Two-Aged Decoction) to stop it. (The smallpox color must be purple-red. Remove Chen Pi [Tangerine Peel], Zhi Gan Cao [Prepared Licorice Root], Bai Fu Ling [Poria], and Zhi Ban Xia [Prepared Pinellia]; add Jiang Zhi Chai Hu [Ginger-processed Coptis] and Jiang Zhi Zhi Zi [Ginger-processed Gardenia Fruit]. Decoct and take slowly. Stop taking when vomiting ceases, as Fu Ling and Ban Xia may dry out the Yangming channel.) Vomiting substanceless material without sound, neither sour nor bitter, followed by fatigue and loss of appetite, indicates deficiency of stomach qi. The main formula is Shensha Hewei San (Ginseng and Amomum Harmonizing Stomach Powder). (The smallpox color must be pale.)

Diarrhea also has two aspects. Diarrhea with yellow, foul-smelling stool and dark, scanty urine indicates the rushing and overflowing of toxic pathogens. The smallpox color must be red-purple. The main formula is Jiawei Siling San (Modified Four-Poria Powder). (For treating heat-type diarrhea: Zhu Ling [Polyporus], Mu Tong [Akebia Stem], Ze Xie [Alisma Root], Chi Fu Ling [Red Poria], Che Qian Zi [Plantago Seed], Huang Lian [Coptis Rhizome], Huang Qin [Scutellaria Root], Niu Bang Zi [Arctii Fructus], Deng Xin Cao [Juncus Medulla]. Take before meals.) Diarrhea with greenish-white, slippery stool indicates deficiency-cold. The smallpox color must be pale white. The main formula is Shenshu San (Ginseng and Atractylodes Powder). (An excellent prescription for stopping diarrhea, specifically for deficiency-cold: Bai Zhu [Atractylodes Rhizome], Ren Shen [Ginseng Root], Bai Fu Ling [Poria], Sha Ren [Amomum Fruit], Zhi Gan Cao [Prepared Licorice Root], Yi Yi Ren [Coix Seed], Lian Rou [Lotus Seed Flesh], Shen Qu [Medicated Leaven], Zha Rou [Crataegus Flesh], Rou Dou Kou [Myristica Seed], Ke Zi [Chebula Fruit], Chen Pi [Tangerine Peel], Nan Mu Xiang [Costus Root]. Grind into fine powder. Take two qian each time, mixed with clear rice soup, warm and taken before meals. If children refuse to take it, mixing it into thin porridge is acceptable.) If deficiency-type sliding diarrhea does not stop, combine with Qiwei Doukou Wan (Seven-Ingredient Myristica Pills). (Rou Dou Kou [Myristica Seed], Ke Zi [Chebula Fruit], Sha Ren [Amomum Fruit], Nan Mu Xiang [Costus Root], Bai Long Gu [Fossilized Bone], Chi Shi Zhi [Halloysitum Rubrum], Ku Bai Fan [Calcined Alum]. Make pills with wheat paste, size of mung beans. Take thirty pills with clear water each time, or crush and mix into porridge. Families treating smallpox must prepare these pills and powders in advance to prevent deficiency-sliding diarrhea. If sudden, unceasing diarrhea occurs during the swelling or crusting stage, death is imminent. Decoctions for stopping diarrhea are often ineffective; some patients continue to have diarrhea even after taking Yigong San (Extraordinary Power Powder). Only these pills and powders can stop it immediately. Only toxic-heat-induced diarrhea can be stopped by Jiawei Siling San.)

During the swelling and suppurating stages, if there is no bowel movement for six or seven days, causing abdominal blockage, stuffiness, and pain, it is due to excess toxicity and constipation. Use Qingdu Huoxue Tang (Clear Toxins and Invigorate Blood Decoction), remove Ren Shen [Ginseng Root], add Huai Niu Xi [Achyranthes Root] 2 qian, increase Zi Cao [Arnebia Root] and Dang Gui [Angelica Sinensis Root] to 2 qian each. After decocting and removing dregs, add half a wine glass of raw honey and take. If still obstructed, add Jiu Chao Da Huang [Wine-processed Rheum Root] 3 qian to the previous medicine to mildly promote bowel movement. If still obstructed, insert pig bile into the anus to facilitate passage. Ultimately, do not use Mang Xiao [Mirabilite] and Da Huang [Rhubarb] for severe purgation, as post-purgation complications could be dangerous.

If the body is cool but sweating incessantly, the main formula is Gui Huang Tang (Angelica and Astragalus Decoction). (Dang Gui Shen [Angelica Sinensis Root Body], Zhi Huang Qi [Prepared Astragalus Root], Suan Zao Ren [Ziziphus Seed]. Decoct in water and take.)

If there is phlegm, use Bai Fu Zi [Typhonii Rhizoma], ground with warm water, and take. Do not use Erchen Tang (Two-Aged Decoction), as it may dry out the Yangming channel, leaving isolated yang without yin, unable to transform. It is safe to use during the crusting and falling-off stage.

Shao stated: During the suppurating stage, first appearing tender yellow, turning old yellow after one and a half days, with normal urination and defecation after one and a half days, and normal diet, is auspicious.

During the suppurating stage, the nursing mother can take ginseng medicines to tonify herself, ensuring good milk to nourish the infant, thereby preventing depletion of acquired primordial qi. During the filling stage, strictly prevent the infant from scratching randomly. If allowed to scratch and break the skin, the righteous qi will leak out, and there will be no rescue. If the smallpox turns from dry and scorched to red and yellow during the filling stage, it is surely due to accumulated virtue.

If the smallpox is initially yellow, which is very good, but later the head becomes scorched white and the face becomes thin and flat, it indicates death. If the base of the pustule is soft like a water blister during the filling stage, death occurs in seven days. If the pus feels rough and breaks gradually during the filling stage, it indicates death. If the blisters are initially red-yellow, which is favorable, but suddenly rot and decay with bad odor, it indicates death. If the pus smells foul and causes itching and pain during the filling stage, use Qingjie Tang (Clearing and Resolving Decoction) to save the patient. If the patient experiences alternating fever and chills, blocked urination and defecation, and spontaneous opening of the eyes during the filling stage, death occurs after six days. If there is one black, sunken, pus-less spot on the palms, soles, anterior chest, posterior chest, and one black spot on the waist during the filling stage, it indicates death. Unceasing pain during the filling stage indicates qi stagnation. (Baoyuan Tang added with Mu Xiang [Aucklandiae Radix] and Shan Zha [Crataegi Fructus] to move stagnant qi.)

Unceasing itching and collapse during the filling stage indicates excessive blood. Blood tastes salty; when it soaks the skin and flesh, it causes itching. (Baoyuan Tang doubled with Huang Qi [Astragali Radix] and Shao Yao [Paeoniae Radix] to restrain excessive blood qi.) Itching when the pus is full is not a problem. If patches rot and the pus remains wet during the filling stage, internally tonify qi and blood significantly, and externally apply Baicao San (Decayed Grass Powder). If the top is flat and the base is wide, and the pus is insufficient, use Shiquan Dabu Tang (Complete Great Tonifying Decoction) added with Mu Xiang [Aucklandiae Radix] and Gan Jiang [Zingiberis Rhizoma]. If the color is white like crystal with no internal pus during the filling stage, use Neituo San (Internal Support Powder) added with Ding Xiang [Caryophylli Flos] and Gan Jiang [Zingiberis Rhizoma], or Muxiang San (Aucklandiae Powder) taken with Mi [Glutinous Rice] and Ren Ru Jiu [Human Milk Wine]. (Song says: Smallpox color void and bright like crystal, do not view this case lightly. Guard against itching and collapse on the eleventh or twelfth day; life will decline on the fourteenth or fifteenth day.)

Xi Taishun stated: At the period of six or seven days, one must wait until the pus is half-full for the pustules to become clearly visible. Heavy toxicity with obstruction leads to dryness, shrinkage, purple brilliance, and black sinking. Abundant qi and rising lead to fullness and radiance. Deficient blood failing to adhere leads to loose and dull bases. Deficient qi failing to converge leads to sunken, non-pointed, and soft tops. If the face and head are filling with pus while the limbs have not risen, do not panic. If the legs are blistering while the face and forehead are scorched and dry, do not rejoice. One fears choking upon eruption and panting upon urgency; choking worries about loss of voice, and panting fears abdominal distension. Insufficient food intake may lead to visceral deficiency and internal collapse. Frequent intake of liquids may lead to diarrhea and convulsions. Improper regulation can reverse the situation instantly. With severe heat and irritability/thirst, do not diagnose as excess syndrome. With added loose stools, diagnose as deficiency at this time, and heavily use formulas containing Ren Shen [Ginseng Root], Fu Ling [Poria], Jiang [Ginger], Can [Bombyx Batryticatus], and Mu Xiang [Aucklandiae Radix]. Severe heat and irritability/thirst can also involve heat diarrhea; how can it generally be diagnosed as deficiency? However, if heat toxin is郁遏 (depressed and obstructed), the body must have high fever, the spots must be red-purple, solid, and rough to the touch, the lips must be cracked and scorched, and the stool must have a foul odor. Use Da Huang [Rhei Radix et Rhizoma], Shi Gao [Gypsum Fibrosum], and Chuan Lian [Meliae Cortex] to clear the toxicity. If the entire skin and flesh are generally red, swollen, with heads large as melons, hoarse voice, choking, shivering, teeth grinding, delirious speech, picking at clothes, and inability to swallow, this is a death omen.