Supplemented Four Sages Powder

It is 四聖散 with four drugs added and the whole thing cut to four pun a drug: costus root to move the qi, astragalus and ginseng to supplement it, cnidium to move the blood, cicada shell for the surface, and a hundred grains of glutinous rice instead of fifty. 能養而發之 — it can nourish and so bring them out — is the 入門's own statement of what the additions are for, and it is a coherent piece of reasoning: if the eruption is sunken because the child is too weak to push it out, then supplement the child and the eruption will rise. **陷伏 is the sign the formula was built for, and it is the worst sign in the section.** Lesions that stayed soft, flat or sank instead of standing up firm and round are the flat type of smallpox and, where there was bleeding into them, the haemorrhagic type. Discrete firm vesicles meant an ordinary illness with a reasonable chance; **a flat, dusky, confluent eruption that failed to raise was nearly always fatal, and usually killed before the pustular stage.** The chapter is right that this is the thing to fear, right to group it with 倒靨 and with 一切惡候, and right that it signals a child who is failing rather than a rash that is merely late. It is wrong about why. The lesions did not sink because the child was weak; the child was dying because of the form the infection had taken, and the flat lesions and the collapse were two faces of the same overwhelming viraemia. Ginseng and astragalus could not reverse it, and nothing could. On smallpox having no treatment at all, see sodok-eum-soa. **The patient is a child with smallpox, and the leaf gives drug weights but no dose scaled to the child's age or weight.** The doses here are very small — four pun is about 1.6 g — which is the one respect in which the formula is cautious. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.