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Fu (entrapment) refers to the pathogenic toxin accumulating internally without being able to emerge. Xian (sinking) refers to the pathogenic toxin emerging but subsequently sinking back inward. Both are ominous signs. Fu presents as a single syndrome, whereas Xian has several types. The signs of Fu appear when the lesions manifest; at this time, the patient develops sores, yet the fever does not significantly decrease, accompanied by irritability, thirst, chest stuffiness, and restlessness. This indicates that latent toxins have not been fully expelled. Xian occurs after the lesions have manifested. If the fluid within the sores gradually dries up and turns black, it is called "Black Sinking" (Hei Xian). If the pustules rupture, itch, and collapse before forming properly, it is called "Inverted Sinking" (Dao Xian). If pus forms but then reverts to water-like fluid and fails to scab over, it is called "Inverted Scabbing" (Dao Ye), which also belongs to the category of sinking syndromes. Any sore presenting with black coloration is termed Black Sinking. All rashes turning black are considered intractable because the Kidney corresponds to Water, and its associated color is black; thus, blackness represents the revelation of the true organ color of the Kidney. Incompetent physicians fail to understand the principle of "blackness returning to the Kidney." They erroneously believe that the Kidney should not be tonified (in the sense of avoiding excess) and attempt to drain the Kidney to induce deficiency. They do not realize that the human body, broadly speaking, consists of Yin and Yang, and specifically, the Heart and Kidney—what medical texts refer to as True Water and True Fire. The fire-toxin of rashes originates internally and relies on this trace of True Water to restrain its hyperactivity. If one attempts to drain it, the fire-toxin loses its restraint, and the root foundation is undermined. How can this be the essence of treatment? However, saying the toxin "returns to the Kidney" is because the Kidney governs bone marrow and closure/storage. The filth and toxin of rashes travel from the bone marrow to the muscles, skin, and hair, moving from inside out, allowing the toxin to be vented. Now, having sunk and entrapped, it moves from outside back inside, hiding in the bone marrow; hence it is called "returning to the Kidney." Furthermore, when rashes first manifest, it is the season of Spring, governed by the generating Qi. If they turn black upon emergence, it is Winter's command acting in Spring. During the stage of rising fever (Qi Zhuang), it is Summer, governed by the nurturing Qi. If they turn black during eruption, it is Winter's command acting in Summer. During the stage of nourishing pus (Yang Jiang), it is Autumn, governed by the solidifying Qi. If the dried pus turns black, it is Winter's command acting in Autumn. Therefore, all these are termed adverse conditions. During the scabbing stage, it is Winter, governed by the storing Qi; this is the normal state of the Kidney. If no scab forms and pus infiltrates, it is Spring/Summer's command acting in Winter, also termed adverse. Only those who understand the mechanisms of natural transformation can discuss the theory of "returning to the Kidney." The color black relates to Fire transformation; observing that objects burned dry turn black, and things emerging from fire are black, how can one claim this is Water? The Classics state: "When Fire activates, it causes smoldering and obscurity." Understanding this allows one to discuss Black Sinking.

For cases where rash toxins are entrapped and fail to emerge, Shuangjie San (Double Resolution Decoction) is the primary formula (for initial heat stages). If the spots are white or black, the patient will likely refuse milk, experience spontaneous diarrhea, vomiting, or cold limbs. This is due to Stomach Qi deficiency failing to support Ying and Wei (Nutritive and Defensive Qi). It is appropriate to use warming Middle Jiao agents to warm the Stomach; once Ying and Wei circulation resumes, the rash will naturally emerge. Suitable formulas include Lizhong Tang (Regulate the Middle Decoction for vomiting/diarrhea in smallpox) and Dingxiang Zhusan (Clove Boiled Powder for vomiting/reversal in smallpox). For inverted sinking, assess the bowels. If constipated, Sishun Qingliang Yin (Four Compliance Cooling Drink for fever) combined with Duoming Dan (Life-Restoring Pill for manifestation stage) is indicated. If there is diarrhea and weak Qi, Shiquan Dabu Tang (Ten Thousand Benefits Decoction for sweating stage) combined with Duoming Dan is indicated. Externally, apply Huisu Jiu (Coriander Wine) and Shuiyang Tang (Water Poplar Decoction, both for eruption stages). Master Danxi stated: Inverted sinking of smallpox is caused by deficiency of True Qi preventing complete expulsion of toxins; treat with Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), and Zicao (Arnebiae Radix) prepared with wine. If the lesions become pale just before maturation, it belongs to Blood deficiency; use Danggui (Angelicae Sinensis Radix) and Chuanxiong (Ligustici Chuanxiong Rhizoma), possibly adding Honghua (Carthami Flos) and Zicao. If belonging to Heat-Toxin, use Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), Jiegeng (Platycodonis Radix), and Qiaoyao (Forsythiae Fructus). For severe cases, use Xijiao Xie (Rhinocerontis Cornu Fragmenta) to resolve large amounts of toxin. [Xue Ji] privately opines that if Heat-Toxin is just emerging but suddenly blocked by Wind-Cold closing the muscle pores, causing blood stasis, body pain, slight limb coldness, failure of spots to grow, or turning cyanotic/black/purple, this is Dao Ye (Inverted Scabbing). If Stomach Qi is weak and cannot supplement Ying and Wei, causing the rash to emerge and then vanish, this is Xian Fu (Sinking Entrapment). Misusing detoxifying herbs will inevitably lead to collapse. If the patient prefers hot drinks and has cold hands and feet, it is a syndrome of Spleen-Stomach damage with Yang Qi deficiency and Cold; treat with acrid-hot tonics. If the patient prefers cold drinks and has hot hands and feet, it is a syndrome of excessive Yang Heat; treat with bitter-cold purgatives. For external Wind-Cold, use warming dispersal. For toxins entering the abdomen, use separating and draining methods. For Yang Qi deficiency, use warming tonification. For external Cold invasion, use fumigation and resolution. Historically, it was said that White Sinking is incurable. Generally, white spots turn gray and miserable; gray and miserable spots flatten and collapse, hence called White Sinking. This is indeed caused by Qi deficiency, but since Blood fails to provide luster, Blood is also fundamentally deficient. Treatment must address both Qi and Blood. When Blood circulates and Qi moves, white can turn red, preventing sinking. If only Qi is tonified, Qi becomes overly dry and hot, inevitably leading to sinking. Thus, if white sinking is scratched, with thin, dry, intensely itchy skin, it results from neglecting Blood tonification, leading to extreme Qi excess and dryness. Using more Qi-tonifying herbs is a sign of imminent death. Therefore, for any white spots, regardless of timing, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Siwu Tang (Four Substances Decoction). If internal heat exists, add detoxifying herbs or promote urination. If treatment is delayed until White Sinking is established, it is difficult to effect a cure. Smallpox presents with Purple-Black Sinking and Gray-White Sinking. Purple-Black Sinking is due to Blood Heat causing stagnation, with Qi unable to circulate; this is an excess syndrome. If treated urgently, survival is likely. Gray-White Sinking is due to exhaustion of Yuan Qi (Primal Qi), preventing eruption and Blood penetration; this is a deficiency syndrome, often difficult to save.

If eruption is impending and sores contain fluid but are dark black, use Shiquan Dabu Tang (Ten Thousand Benefits Decoction) to administer Wuji San (Priceless Powder). Alternatively, combine Kuaiban Tang (Rapid Eruption Decoction) and Duoming Dan (Life-Restoring Pill).

For inverted scabbing, again assess the bowels. If constipated, promote unblocking with Sanhuang Wan (Three Yellows Pill) or Sishun Qingliang Yin (Four Compliance Cooling Drink). If diarrheic, tonify with Shiquan Dabu Tang (mild cases) or Chen's Muxiang San (Chen's Costus Powder for severe cases), externally applying Baicao San (Decayed Grass Powder).

[Pang Anchang] Yujin San (Curcuma Powder): For smallpox starting with white blisters, suddenly retracting into the abdomen, gradually turning purple-black, lacking pus, with day-and-night crying and agitation.
Yujin (Curcumae Radix, 1 piece) Gancao (Licorice Root, 1 fen)
Boil in half a bowl of water until dry. Remove Gancao, slice, bake dry, and grind to fine powder. Add Naozi (Borneolum Syntheticum, half qian), mix with 1 qian of powder. Take with 5-7 drops of fresh pig blood, mixed with fresh well water. Within two doses, severe toxins will exit via the palms and soles like boils, indicating recovery. This is a critical condition with five deaths to one life.

Sisheng San (Four Sages Powder): For black sinking, inverted scabbing, lack of eruption, non-vibrant color, and difficult urination.
Zicao (Arnebiae Radix) Huangqi (Astragali Radix) Gancao (Licorice Root) Mutong (Akebiae Caulis)
Decoct in water and drink. If heat is severe and color purple, double Zicao, add Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), and Honghua (Carthami Flos). If constipated, add Zhike (Aurantii Fructus). If normal, add Nuomi (Oryza Sativa Glutinosa).

Shenneituo San (Ginseng Internal Support Decoction - see Itching/Collapse section)
Wuji San (Priceless Powder)
Use human, cat, pig, and dog feces, burned to ash in the twelfth lunar month. Mix with rock sugar water and take.

Nanjin San (Southern Gold Powder): Treats rashes that emerge and then sink, a critical condition unresponsive to other drugs, ensuring safety.
Zibei Heye (Purple-backed Lotus Leaf, harvested after frost) Baijiangcan (White Silkworm, washed free of silk, stir-fried dry)
Grind to powder. Equal parts. Dosage depends on age: adults 1 qian, children 0.5 qian. Grind with Yuanxu juice (Coriander juice) and wine, or rice water.
Treating this condition often involves Longnao (Borneolum) and Renya (Human Teeth), which are hard to obtain. This formula is non-toxic and fast-acting. Purple-backed leaves are rare; check salt shops.

Golan Yin (Olive Drink): Treats inverted scabbing.
Cut olives in half. Take a small amount with water. Eruption occurs immediately.

Baihuashe San (White-Banded Snake Powder): Treats smallpox/rash black sinking and inverted scabbing.
Baihuashe (Bungarus multicinctus, including bones, 1 liang, fire-dried but not burnt) Dingxiang (Caryophylli Flos, 20 pieces)
Grind to powder. Take 0.5 qian or 0.2 qian with hot wine. For black sinking, if color turns red after a while, it is very effective.

*Luofu Fang* (Luofu Formula) for collapsed smallpox. Verse:
"Wu She (Bungarus multicinctus), Quanxie (Scorpio), and Jiangcan (Silkworm),
Along with Shan Jia (Pangolin scales) with meat attached.
Take one liang of each purified ingredient,
Add twice the amount of Guan Gui (Cinnamomi Cortex).
Boil in strong white wine and drink as desired;
Many collapsed cases will recover completely."
I have used this frequently, saving many lives. Note: Jiangsan must be cleaned of silk and lime dust, then dried. Use the best tail of Wu She. Wash Shan Jia in wine and bake dry.

[Yuan Shi] Treating inverted scabbing. Verse:
"Inverted scabbing is difficult post-smallpox,
Due to mutual depletion of Qi and Blood.
Ren Shen (Ginseng), Huang Qi (Astragalus), Dang Gui (Angelica), Di Huang (Rehmannia), and Chan Tui (Cicada Slough),
Taken continuously, scabs will return naturally."
Another verse:
"If inverted scabbing bleeds incessantly, it is called 'Returning Yang Spring.'
If it affects the chest and hypochondrium, nine out of ten die.
Quickly find Yan Zhi Pei (Alkanna tinctoria embryo), add one qian of Xue Jie (Dragon's Blood).
Burn them preserving their nature, apply to stop bleeding and dry the wound."
I have seen many mistakenly use bathing methods for post-smallpox inverted scabbing, causing unnecessary deaths. If scabs pile up with pus and cannot detach, or detach partially, or detach around the edges but cause piercing pain in the center, use the following formula:
Sheng Mi (Raw Honey) Suhe You (Styrax Oil)
Mix evenly. Apply along the edge of the scab base with a silver needle. Pain stops immediately, and scabs detach quickly without bleeding or flesh damage. If Suhe You is unavailable, substitute with Ji You (Chicken Fat), which is also excellent.