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Xu Zhongguang treated a child whose pustules were full, but due to exposure to foul air, the pustules inverted and turned scorched black, accompanied by swelling and pain in the four limbs. Fortunately, the child could eat and had regular bowel movements, indicating that the righteous qi was not retaining pathogenic factors, and an abscess would likely develop. He used a decoction for internal support and detoxification, and the child recovered.

Another child at seven days of age showed a smooth progression of smallpox with signs of pustule formation, but both arms swelled as large as melons. Fortunately, the child could eat and had regular bowel movements. This was due to deficiency in the Shaoyang channel and stagnation of toxins that failed to disperse. By tonifying yang, the swelling resolved spontaneously. The treatment involved Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), Cinnamon Twig (Guizhi), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Citri Reticulatae Pericarpium (Chenpi), Angelicae Dahuricae Radix (Baizhi), Notopterygii Rhizoma et Radix (Qianghuo), and Human Middle Yellow (Renzhonghuang). As the pustules matured, the swelling gradually subsided, and the child recovered.

In another case with identical symptoms, no tonification was performed. Although the pustules were full, pus formed at the sites of scabbing and swelling, resulting in the loss of one eye.

A five-day-old child presented with swelling and pain in both arms. After using dispersing agents, the pustules did not fill, and the toxins did not recede; instead, chills and itching occurred, making the condition critical. This was because the exterior was addressed urgently without proper internal support and tonification. Baoyuan Decoction (Preserve the Origin Decoction) was modified with Clove (Ding), Cinnamon Bark (Rougui), Atractylodis Macrocephalae Rhizoma (Baizhu), and Tangerine Peel (Jupi). As the pustules filled, scabs formed. Subsequently, using formulas for supporting the interior and resolving toxins allowed the toxins to suppurate and heal.

In a case of dense smallpox with strong internal constitution, excessive tonification led to abscesses, irritability, thirst, and constipation. Sanhuang Pill (Three Yellows Pill) was used to purge, followed by clearing and resolving agents for regulation, leading to recovery after the swelling subsided.

A child suffered from a smallpox-related carbuncle on the lower leg for over a year, which remained ulcerated and unhealed. Located in the region of extreme yin, lacking the expansion of yang qi, and with prolonged discharge of pus and blood, the qi was cold and weak. It was appropriate to tonify the primordial qi. Qianjin Neituo San (Internal Support Powder from Essential Prescriptions of a Thousand Gold Value) was modified with Achyranthis Bidentatae Radix (Niuxi), Arecae Semen (Binglang), Smilacis Glabrae Rhizoma (Tufuling), and Polygoni Multiflori Radix (Shouwu). A piece of tender bone emerged upon ulceration, and the wound gradually healed. This is because long-standing toxins condense like bone, consistent with the principle of "earth generating metal."

In another case, smallpox toxins flowed into four or five locations on the shoulders and arms. The scabs were thin like bran, the spirit was low, and the scabs adhered tightly without falling off, indicating deficiency of qi and blood. Shixuan Tuoli San (Ten Acupoints Interior-Supporting Powder) was administered internally. Externally, the lesions were pricked with needles, and Yulong Gao (Jade Dragon Ointment) and Tiegu San (Iron Hoof Powder) were applied to surround and absorb the pus using suction cups. The child recovered.

In a case where smallpox toxins manifested as clear fluid, the six pulses were faint, indicating deficiency and cold of the primordial qi. Baoyuan Decoction was modified with Cinnamon Twig (Guizhi), Prepared Aconite Root (Fuzi), and Atractylodis Macrocephalae Rhizoma (Baizhu). Regulation led to recovery.

A child presented with swelling and pain in the thigh, caused by toxic fire郁结 (stagnating) in the muscle layers, constituting erysipelas (Dan zhong). The treatment included Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Moutan Cortex (Danpi), Rehmanniae Radix (Dihuang), Forsythiae Fructum (Qiaoyu), Angelicae Dahuricae Radix (Baizhi), Chaenomelis Fructus (Mugua), and Rheum Palmatum Radix et Rhizoma (Dahuang).

A case presented with redness and swelling behind the ear with palpable nodes, accompanied by aversion to cold and fever, head swelling, and body pain. This was caused by invasion of abnormal qi, classified as epidemic toxin (Shidu). Shishen Jiedu Tang (Ten Gods Detoxifying Decoction) was used, and the child recovered.

In a case where pustules were full but the four limbs were cold and thin like water, and scabs were thin like bran, on the twelfth day, swelling and pain appeared in both shoulders and arms. Some attributed this to residual toxins and prescribed blood-nourishing and detoxifying herbs, leading to poor appetite and fatigue, with toxins remaining unresolved. This indicated yin deficiency with stagnant toxins failing to transform. Large doses of qi and blood tonics combined with detoxification were required. Once qi and blood flowed smoothly, the toxins gathered in one place, suppurated, and transformed. Sijunzi Tang (Four Gentlemen Decoction) was modified with Citri Reticulatae Pericarpium (Chenpi), Paeoniae Radix Alba (Baishao), Angelicae Sinensis Radix (Danggui), Angelicae Dahuricae Radix (Baizhi), Zingiberis Rhizoma Recens (Shengjiang), Forsythiae Fructum (Qiaoyu), and Lonicerae Japonicae Flos (Yinhua). Large doses were adjusted and regulated until recovery. If only detoxification were used, it would damage the spleen and stomach, causing diarrhea, vomiting, cold extremities, and depletion of true yuan. In such cases, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) modified with Myristicae Semen (Rouguo) and Aucklandiae Radix (Muxiang) would be appropriate. If limb heat, pain, and swelling occurred, Sijunzi Tang was modified with Lonicerae Japonicae Flos (Yinhua), Scutellariae Radix (Huangqin - inferred from context "Huang"), and Angelicae Dahuricae Radix (Baizhu) for recovery. If detoxification alone were used without consolidating primordial qi, and only external surrounding pastes applied, although swelling might subside, toxins would remain internal, leading either to loss of limbs or death from abdominal distension and wheezing.

Wan Mizhai treated Zhou's daughter who had fever during smallpox eruption for over five days without visible spots, but developed a swollen toxin on her back. He said, "It is untreatable. It is not an abscess, but 'Doumu' (Smallpox Mother)." Three days later, she died suddenly. (Commentary by Xiong Lingtai: If swelling occurs behind the cheek after variolation, it is also called 'Doumu', which is actually auspicious.)

Zhang's daughter's smallpox rose but remained empty shells, indicating excess qi and insufficient blood, pointing to liver channel pathology. Siwu Tang (Four Substances Decoction) and Xiaochaihu Tang (Minor Bupleurum Decoction) were used. Although pus formed, it was not full before scabbing. He stated, "Whenever smallpox does not form pus or has little pus, it will develop into carbuncles. This is liver disease of the Foot Jueyin channel, inevitably leading to a carbuncle on the vertex." This proved correct.

Shi Jiquan orally transmitted a family secret recipe for treating post-smallpox toxins effectively. It consisted of Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Lonicerae Japonicae Flos (Yinhua), and Rhinocerotis Cornu (Xijiao), each 3 qian; Licorice Root (Gancao) 1.5 qian; Antelope Horn (Lingyangjiao) 1 qian; and Pearl (Zhenzhu) 0.8 fen. These were made into honey pills, taken 1 qian once daily. (From *Guang Biji*.)

Wan Mizhai treated Hu's daughter whose smallpox was not very dense nor particularly robust and full. She was afraid of medicine and refused to take it. During the scabbing phase, a thin shell formed, indicating a adverse prognosis. Carbuncles developed on her feet and knees. She took a dose of medicine in one go. Wan said, "The disease is incurable." When asked why, he replied, "The spleen governs taste and opens into the mouth. The classics state that if the mouth functions well, one can discern the five flavors. Her refusal to take medicine normally, followed by swallowing a dose completely today, indicates loss of taste sensation and failure of the spleen. Moreover, the knees are governed by the spleen; if the spleen fails, pus cannot form." Needling indeed yielded clear fluid, and she died the next day.

Xia's son developed carbuncles on his hands and feet after smallpox, with dark complexion, mental fatigue, and reduced appetite. Wan said, "The child's smallpox did not reach a vigorous stage, and scabbing was too hasty. Now carbuncles have developed, indicating inversion returning to the kidney. Pus will not form, and death is inevitable." This proved true.

A child developed a carbuncle after smallpox. Shiquan Dabu Tang (Complete Great Tonifying Decoction) modified with Forsythiae Fructum (Lianqiao) and Lonicerae Japonicae Flos (Yinhua) was used, resulting in recovery. Since the carbuncle had already ulcerated, this formula was appropriate. For any ulcerated carbuncle, this method ensures recovery.

Another child developed a carbuncle after smallpox. Jiedu Neituo San (Detoxifying Internal Support Powder) was used for regulation, leading to stability.

Cai's son had scrotal swelling after smallpox. Wan diagnosed it as Jueyin liver disease. Xiaochaihu Tang (Minor Bupleurum Decoction) modified with Tangerine Peel (Qingpi), Akebiae Caulis (Mutong), and Crataegi Fructus (Zharonrou) was used for regulation, resulting in recovery.

Fei Jianzhong stated: A child had only 83 smallpox spots. Someone used mild agents according to the standard timeline. By the 16th day, everyone thought recovery was effective. Invited to see the child on the 26th day, the eyes were wide open in terror, as if facing execution, with incessant dry heaving and extreme distress. Small toxins the size of peach pits, hidden in the muscles near the scrotum, were dark in color. This was residual toxins stifled within. Fei declined treatment, and the child died that night.

A half-year-old child had sparse but bright red smallpox, with high fever like fire. After pustule formation, the child became restless, and scabs formed instantly. The red halos were crimson, and scabs were scorched and dry. Two palm-sized carbuncles appeared on the waist and Huantiao acupoint, hard as stone and swollen as fists, along with numerous small boils. Bisheng Tang (Sure Victory Decoction) was given twice daily, and Huadu Dan (Toxin-Resolving Pellets) mixed with madder root juice were applied topically. The boils gradually receded, and the carbuncles suppurated. Rendong Jiedu Tang (Honeysuckle Detoxifying Decoction) modified with Siegesbeckiae Herba (Diding) and Angelicae Sinensis Radix (Danggui) brought about recovery. (This is commonly known as "scabbing while fire remains"; if carbuncles do not develop, death is certain.)