Resolve Toxin Siler Decoction

Siler at a don with six drugs at five pun behind it, and the composition is doing three things at once: siler, schizonepeta spikes and burdock seed vent outward, lycium root bark cools the deep fever, astragalus and white peony hold the qi and the blood for the 氣弱, and bitter orange moves the chest. It is one of the few formulas in the section built for a child who is failing rather than for a rash that is slow. **The clinical picture in the second clause is three real signs of severe smallpox put together correctly.** 痘出速且密 is density again — the lesion count that predicted mortality better than anything else, and an eruption that came out all at once was the confluent pattern. 七日後壯熱 is the fever still high a week in, which in the real natural history is the suppurative stage, when the pustules filled and the second fever rose; a child burning on day seven with abundant lesions was in the part of the illness that killed. 氣弱 is prostration. And **聲啞, the voice gone, is the pharyngeal and laryngeal lesions.** Smallpox erupted on mucous membranes as well as skin — mouth, pharynx, larynx, trachea — and those lesions ulcerated early; hoarseness and then loss of voice marked them. In a small child, whose airway is narrow and whose larynx is the narrowest part of it, laryngeal involvement meant swelling in the one place it could not be afforded, and airway obstruction was a mode of death. The same lesions, shedding virus into the mouth and throat, are also why the disease spread by droplet. The chapter has assembled a list of bad signs that a modern clinician would recognise as a list of bad signs. None of which the formula could address. A child obstructing at the larynx needs an airway, and that is the whole of the honest reading here. 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.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.