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This is a syndrome of excess, more severe than macules (maculae). It involves toxin floating upward with heat, emerging from the hair follicles, resembling mosquito bites in shape and appearing purple-red. It is appropriate to use Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Bohe (Menthae Haplocalycis Herba), Niubangzi (Arctii Fructus), Huanglian (Coptidis Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Zhizi (Gardeniae Fructus), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), and Dahuang (Rhei Radix et Rhizoma), which will yield miraculous effects.

If after the eruption of smallpox lesions appear fine and dense like mustard seeds, these are macules (maculae). If the skin and flesh are bright red and form patches, these are maculae (maculae/patches - note: in TCM context here distinguishing 斑 ban as larger patches vs 疹 zhen as smaller spots). This is caused by fire-toxin steaming and scorching internally; it is urgent to resolve toxicity so that the maculae and rashes dissipate, allowing the smallpox to complete its course. The Classics state: "Smallpox and rash appearing together is very rare; mixed with maculae or rashes is generally unfavorable. First dissipate maculae and rashes, then resolve toxicity; Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), and Xuanshen (Scrophulariae Radix) are suitable." It also states: "When rash appears first and smallpox later, the child cries; only after the rash recedes can the smallpox emerge naturally. Do not worry that cold-natured drugs will cause 'ice-fusion' (internal stagnation); contemporary physicians often act foolishly upon seeing this." It further states: "In treating rashes without attending to smallpox, one must open the couli (skin pores and interstices). Once the couli are open, toxins exit naturally, which indicates a peaceful prognosis." It also states: "First subside the measles/rash, and the smallpox will naturally erupt vigorously. It is suitable to take Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Fangfeng (Saposhnikoviae Radix), Huangqin (Scutellariae Radix), Jingjie (Schizonepetae Spica), Huangbai (Phellodendri Cortex), Xuanshen (Scrophulariae Radix), Niubangzi (Arctii Fructus), Shigao (Gypsum Fibrosum), plus Shengma (Cimicifugae Rhizoma)."

Red-purple and dry/stagnant, or black and scorched/dry, indicate exterior heat and excess. Constipation, dark and painful urination, fever, dry nose, hot breath, cracked lips, irritability, and thirst indicate interior heat and excess. Exterior heat should be treated with cooling, dispersing, and draining methods. Interior heat should be primarily treated with heavy detoxification, combined with cooling and dispersing.

The appearance of numerous red spots or carbuncles later indicates heat-toxin suppressed in the skin. The Classics state: "It is best to clear toxicity urgently; do not hesitate to administer Lianqiao Yin (Forsythia Decoction)." There are also cases of bleeding gums and sore throat after the rash. The Classics state: "In Ganjie Tang (Licorice and Licorice Root Decoction), add Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Xuanshen (Scrophulariae Radix), and Niubangzi (Arctii Fructus) to support healing of the damaged gums and tongue." If sores arise, use Lianqiao (Forsythiae Fructus), detoxifying herbs, Jiegeng (Platycodonis Radix), and Xuanshen (Scrophulariae Radix).

Fever with palpitations and fright indicates disease in the Heart and Liver. The Heart governs Fire, and the Liver governs Wind-Wood. When wind and fire clash and excite each other, convulsions occur; they are treated with Shengjie Tang (Ascending and Resolving Decoction). There are also cases of cough, wheezing, and weakness, indicating disease in the Lung and Liver. The Lung governs Qi, and the Liver governs Blood; this represents Metal and Wood combining, with Qi and Blood clashing, which also leads to convulsions; they are treated with Qingfei Yin (Clear Lung Decoction). The Classics state: "The method for treating fright requires soothing the Liver; when water metabolism is promoted, the situation naturally stabilizes." All wind syndromes involving tremors and dizziness belong to Liver-Wood. Excessive Heart-Fire attacks Lung-Metal, preventing it from controlling Water. When Liver-Wood becomes hot, it generates Wind; Wind and Fire clash, disturbing the Shen (Spirit), causing fright and convulsions. The treatment principle is to soothe Liver-Wood and promote urination. Twitching of tendons and trembling of pulses resemble fright. Tendons belong to the Liver. If toxin resides in the Liver but cannot find an outlet to exit, the tendons and vessels are impacted, causing twitching similar to fright, though it is not actually fright. In such cases, use Sujie San (Perilla Resolving Powder), which is Qingjie San (Clearing and Resolving Powder) minus Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma), plus Qianghuo (Notopterygii Rhizoma et Radix) and Zisu (Perillae Folium).