Forsythia and Cimicifuga Decoction

The base is 升麻葛根湯, the standard formula of the whole tradition for an eruptive febrile illness, four drugs with ginger and scallion; forsythia is put in for the 毒盛. That is the entire prescription, and the leaf is really a note on where to add a drug rather than a formula in its own right. **The two similes are confluent smallpox described exactly, and they are worth reading closely.** 如蚕種 — like silkworm eggs — is a sheet of small raised lesions packed side by side with no clear skin between them, which is what a silkworm egg-card looks like and what a confluent eruption looked like on a face or a forearm. 如糠粃 — like bran-chaff — is the fine, flat, widely strewn appearance. **Both are descriptions of lesion density, and density is what actually predicted death**: discrete lesions carried roughly ten per cent mortality, semi-confluent considerably more, confluent over sixty per cent. 一發便密, out all at once and at once crowded, adds the other bad feature, a rash that arrived in a single crop at full density rather than filling in. The chapter is grading by the right things, and the phrase 毒盛 is its way of saying what we would call viral load. 升麻葛根湯 remains in use for measles-type eruptions and is a reasonable thing to give someone with a febrile rash; forsythia is a standard heat-clearing fruit. Neither has any action on a poxvirus, and a child whose eruption came out confluent on the first day had already received the prognosis that mattered before the packet was cut up. On smallpox having no treatment at all, see sodok-eum-soa. **The patient is a child with smallpox, and neither this leaf nor the base gives a dose scaled to the child's age or weight.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.