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Regarding the inversion of smallpox crusts (inverted scabs).

Xu Zhongguang treated a patient with blood-heat type smallpox. Initially, cooling and resolving methods were not used in time. By the fifth or sixth day, herbs such as Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Dihuang), Forsythiae Fructum (Lianqiao), and Pericarpium Papaveris Rubrum (Hongqu) were administered, allowing the pustules to begin rising and swelling. When the filling stage reached half-way, the patient stopped taking medicine. On the ninth day, the color turned black and inverted towards the Kidney; the skin and flesh of the face, lips, waist, and feet all turned black. The previous prescription was continued, adding Golden Juice (Jinzhi) and Human Tooth Powder (Renya). The condition slightly eased, after which Coptidis Rhizoma, Rehmanniae Radix, and Pericarpium Papaveris Rubrum were each used in 1 qian, Aucklandiae Radix (Muxiang) in 3 fen, and Juncus Effusus (Dengxincao) in 1 qian. The next day, Rhinoceros Horn (Xijiao) and Forsythiae Fructum were added. The blackness gradually dispersed, and the lips and eyes cleared. After four consecutive doses of the previous formula, the patient recovered.

Wan Mizhai treated the son of the Wu family. His smallpox lesions were distinct, red, and lively, indicating a favorable course. However, the child had always had weak Spleen and Stomach, and the eruption rose slightly late. Someone suggested it was Qi deficiency and blindly administered one dose of Chen's Muxiang San, causing the lesions to become flat and fail to rise. Another dose of Chen's Yigong San was given. When consulted again, the case was deemed incurable.

The Li family's son developed smallpox at age four. Ten days later, the tops of the lesions were flat and depressed, with red-purple roots. He was lethargic and refused food; the case was incurable, and he died the next day.

The daughter of the Wu family was about to suppurate, but some crusts on her face had already dried, presenting an inverted adverse syndrome. Treatment consisted of Ginseng Radix (Renshen), [missing character, likely Astragali Radix], Glycyrrhizae Radix et Rhizoma (Gancao) tips, Angelicae Sinensis Radix, Rehmanniae Radix, Paeoniae Radix Rubra (Chishao), Lonicerae Japonicae Flos (Yinjinhua), Arctii Fructus (Niubangzi), Forsythiae Fructum, Ephedrae Herba (stir-fried with wine and honey until black), Carthami Flos (Honghua), and powder of Pangolin Scales (Shanjia). Decocted in water. The physician advised: "After ingestion, if the already dried lesions re-rise and suppurate; if the non-dried ones become robust, red, and full, and new small lesions appear in empty spaces, this is the best outcome. If they do not suppurate, do not fill the gaps, or if abscesses form, this is a medium outcome. Otherwise, it is incurable." After three consecutive doses, the already dried lesions did not swell, the non-dried ones filled with pus, few appeared in the gaps, and abscesses developed on the hands and feet. Subsequently, Shiquan Dabu Tang (Decoction for Complete Great Tonification) with added Lonicerae Japonicae Flos and Forsythiae Fructum was used for regulation, leading to recovery.

The grandson of Magistrate Lei developed smallpox at age five. He wore thick brocade clothes, was wrapped in heavy quilts, stayed near fire day and night, and was allowed to drink alcohol. Within seven days, crusts formed, but the face down to the waist became ulcerated and flat, with no scabs forming. The physician said: "This is not normal inverted scabbing. Urgently use herbs to disperse, resolve, and detoxify. Reduce clothing and bedding, avoid fire and alcohol, and safety can be ensured." Astragali Radix and Angelicae Dahuricae Radix (Baizhi) were used to drain pus and support the interior; Saposhnikoviae Radix (Fangfeng) and Bombyx Batryticatus (Chantui) to disperse the exterior; Citri Reticulatae Pericarpium (Qingpi) and Platycodonis Radix (Jiegeng) to regulate the interior; Arctii Fructus and Glycyrrhizae Radix et Rhizoma to detoxify. After one dose, the ulcerated sores swelled again, and pus and mucus were passed in stool, indicating that toxic qi had been cleared from both inside and outside. The physician warned against further medication to prevent other diseases.

Miss Dong, aged nineteen, began developing smallpox in mid-winter but could not crust over by mid-year. Her spirit was confused, and she ate nothing. Examination showed her lying stiffly like a corpse, yet her pulse was surging, solid, and regular. This was originally an inverted adverse syndrome, but fortunately, the pulse was surging and solid, neither rapid nor slow. Therefore, treatment was based on the pulse rather than the symptoms. If the necrotic sores could re-rise and new sores emerge, with clarity of mind and normal appetite, there would be no danger. Thus, Shengyang Jianghuo Tang (Decoction to Raise Yang and Descend Fire) with added Astragali Radix, Angelicae Sinensis Radix, Aucklandiae Radix, and Citri Reticulatae Pericarpium was administered for three consecutive doses. On the third day, a new layer of smallpox emerged, and the old ones dried completely. By the fifth day, all had erupted, covering the body, and she gradually regained consciousness, could speak, and requested food. Following the cycle of eruption, after crusting on the thirteenth day, Shiquan Dabu Tang was used for regulation. It was stated that inverted smallpox inevitably affects the Kidneys. Although cured, eye diseases should be prevented proactively. She did not listen. Half a month later, her left eye hurt and could not open, resulting in blindness. (This case is not entirely accurate; generally, excessive dispersing and raising agents in previous cases caused eye damage. I have seen many cases of inverted scabs recovering without eye injury.)

Mrs. Chai, aged twenty-seven, had very dense smallpox. When pus formed, the tip of her nose dried first. The physician said: "This is a ominous sign, incurable." Asked why, he replied: "The eruption was not thorough, and the pus was not ripe; crusting should not have occurred. Moreover, crusting follows a specific order and appearance. It usually starts from the sides of the mouth, leaking pus and accumulating suppuration, with facial lesions behaving similarly, while those below the neck form shells. Now, the immature smallpox has crusted, which is inversion. Crusting starting from the nose disrupts the order. The lack of leakage indicates dryness and withering." She eventually died.