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When Qi and Blood are deficient and cold, failing to uplift and promote vitality, the smallpox lesions appear grayish-white with depressed tops and scanty pus. One should promptly administer a decoction containing Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Antler Cornu Cervi Pantotrichum (Lurong), and taking it with Cock Comb Blood Wine (Jiguanxue Jiu) yields even better results.

[Note] When smallpox reaches the stage of pustule formation, if the color is pale white, the base lacks a red halo, and the top is depressed, this is termed "White Depression" (Bai Xian). If deficiency becomes extreme, it transforms into "Gray Depression" (Hui Xian). This occurs because Qi deficiency leads to lethargy and lack of vigor, while Blood deficiency fails to fill the pustules; thus, once depression sets in, it cannot be halted. Treatment should focus on greatly tonifying Qi and Blood, preferably using Shen Gui Lu Rong Tang (Ginseng, Angelica, and Deer Horn Decoction). Upon administration, add Cock Comb Blood Wine. Take two to three doses daily. As long as the pustule tops rise and pus flows, danger can be avoided, and health restored.

Shen Gui Lu Rong Tang (See "Treatment of Pustule Formation Symptoms" for formula details)

Cock Comb Blood Wine
Take one large rooster. First, warm a cup of white wine. Then, prick the cock's comb to obtain several drops of blood, drip them into the cup, and mix well. Warm again and mix into the decocted medicine for oral administration.

Purple Depression and Black Depression both result from excessive pathogenic toxin. The lesions are flat, dull, and dark, with tight bases that do not loosen. This indicates that Qi and Blood are constrained by Fire-toxin. Urgent detoxification is required, and Gui Zong Tang (Return to Ancestral Decoction) should be used.

[Note] When smallpox eruptions are dense, with small, fragmented particles, tight roots, dull and dark colors, and depressed purple tops, this is called "Purple Depression." If it worsens and turns black, it is termed "Black Depression." Both conditions arise from the constraint and closure of Toxic-Fire, preventing the free circulation of Qi. Treatment should employ clearing heat and detoxifying methods, primarily using Gui Zong Tang.

Gui Zong Tang (See "Treatment of Fever Symptoms" for formula details)

When the pus is insufficient and the smallpox plate appears yellow, with collapsed tops forming patches and stiff skin, this signifies Qi stagnation and Blood coagulation, making nourishment difficult. This is entirely due to Toxic-Heat invading the Spleen region. One must quickly take a detoxifying and blood-invigorating agent. Once the toxin resolves and the smallpox rises, health will return.

[Note] "Plate Yellow" refers to the condition where, during pustule formation, the pus has not reached half volume, yet sudden yellow protrusions appear, which are dry and hard. This is because fierce toxins肆虐 (run rampant) in the Spleen region, causing Qi stagnation and Blood coagulation, hindering irrigation. Qing Du Huo Xue Tang (Clear Toxin and Invigorate Blood Decoction) must be used. If the smallpox rises, survival is still possible. However, if yellowing appears on the face, neck, eye sockets, lips, and the entire body, the condition is incurable.

Qing Du Huo Xue Tang
Angelicae Sinensis Radix (Danggui), White Peony Root (Baishaoyao - stir-fried with wine), Rehmanniae Radix Recens (Shengdihuang), Arnebiae Radix seu Lithospermi Radix (Zicaorong - washed with wine), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian - stir-fried with wine), Arctii Fructus (Niubangzi - stir-fried), Crataegi Fructus (Nanshan zha), Forsythiae Fructus (Lianqiao - remove heart), Ginseng Radix (Renshen), Astragali Radix (Huangqi - raw), Platycodonis Radix (Jiegeng), Akebiae Caulis (Mutong).
Use Juncus effusus (Dengxincao) as an adjuvant. Decoct in water and take orally.

[Formula Song]
Qing Du Huo Xue Tang is most effective,
Containing Danggui, Baishao, Shengdi, and Zicaorong.
Huangqin, Huanglian, Niubang, Shan zha, and Lianqiao join,
With Renshen, Huangqi, Jiegeng, and Mutong combined.