痘疮灌脓之后，肥泽坚实，以手摸之，疮头硬而微焦，此欲靥也。靥时干净，无突陷淫湿破绽，
色苍蜡，皮坚浓，外明内暗，尖利碍指者，此为正靥。若痘虽似干而痂薄如纸，或有内证未除，此
痘之极险时也，急宜调补，庶不致害。
一、痘疮自出起至十日，十一、二日，当从口唇头面以渐收靥。但自上而下者为顺，自下而上
者为逆，察有他证，速宜治之。
一、将收靥时，而一向身温忽然发热者，名为干浆，是亦常候。此时不可轻用汗下，若有风寒
外感，及饮食所伤，乃当随证治之。
一、痘疮收靥太迟，或当靥不靥者，证有数种，当详辨治之。大部当靥不靥之证，惟脾胃弱，
中气虚者居多。盖中气虚则不能营养肌肉，使之成实，亦或致溃烂也。但察其别无他证而形色气血
俱虚者，宜内用十全大
补汤，外用败草散衬之。若当靥不靥，微热脉大而别无他证者，此阴分之不足也，宜四物汤倍加芍
药、何首乌。若血虚热毒未清者，宜四物汤加牛蒡子、木通、山楂。若因食少脾胃气虚而不收者，
宜六气煎、或六物煎加减主之。若频见泄泻，脾胃弱，肌肉虚，成腹胀烦渴而不收者，宜陈氏十二
味异功散，或木香散，外用败草散敷之。若当靥不靥之际，忽见头面温，足指冷，身不热，或泄泻
腹胀，气促烦渴，急与陈氏十二味异功散，或九味异功煎，迟则不救。凡痘疮将靥之时，而见泄泻
烦渴，腹胀切牙等证，多有难救。若与蜜水生冷等物，必烦躁转加而死。有因饮水过多，或触于湿
气，以致脾胃肌肉湿淫，不收难靥者，宜五苓散，或四苓散加山楂利之。有因热毒未退，肤腠郁蒸
，阴不能敛而当靥不靥者，若不速解，则毒必内攻，为害不浅，宜犀角散加芍药、牛蒡子。有内外
俱热，阳毒散漫，以致大便秘结，阴气不行而当靥不靥者，宜内用四顺清凉饮，或三黄丸以通其便
，外用败草散、猪胆导法。有天寒失于盖覆，疮受寒凝而不收者，宜服五积散，外用乳香，或芸香
于被内熏之。有天热过暖，痘被热蒸不收者，宜内服人参白虎汤，或五苓散、四苓散以利湿热，外
用天水散扑之。有为邪秽阴寒所触，致伤元气而不靥者，宜保元汤，或十二味异功散，外以辟邪丹
熏之，猪髓膏涂之即愈。
一、痘疮内热，毒邪未尽化而干靥太疾者，后必为目疾，成为痈毒，及诸怪证，宜凉血养营煎
少清其火∶若大便过于干结者，宜微利之以解其毒，当归丸主之。
一、痘疮有脓结靥则为善，无脓结靥则为凶，此治之不可缓也。若痘已脓成，不能结靥，而反
致溃烂，或和皮脱去者，此名倒靥，乃毒瓦斯入内也，急须大补中气以托其里，宜六气煎倍加芍药，
及紫草、防风、白芷主之；若兼湿热者，宜六气煎加芍药合四苓散主之。如头面疮破，服补药后
，但得复肿复灌，或遍身无疮处，又出一层，谓之补空，虽过期延日而饮食不减，不为大害。若服
药后不起不补，此毒已入深，最凶候也。
一、痘疮无论已溃未溃，于十二日之后，但得结靥，便为佳兆。若痂皮不结，则必成倒靥。其
有回之未尽，或遍身俱靥而但有数颗不靥者，终致作痒抓破，亦难必其生也，速宜治之。
一、靥时色白如梅花片者，此为假回，十二日后当死，此不治之证也。如不泄泻，可速用六气
煎，或六物煎，合二仙散大进救之。
一、痘疮成脓不靥，以致溃烂，脓汁淋漓，粘着疼痛，不可着席者，用败草散，或荞麦散，以
绢袋盛扑之，更多布席上衬卧尤佳，或用秘传茶叶方亦佳。若欲面上不成瘢者，用救苦灭瘢散，以
密水调敷之。
一、痘疮溃烂先伤于面者，凶兆也。如饮食无阻，二便如常，更无他证者，宜内用十全大补汤。
如毒盛内热者，宜以解毒防风汤加当归、蝉蜕，相间服之，外以救苦灭瘢散敷之。
一、痘疮于未灌之先，或会伤犯破烂成疮，及诸痘收靥，此独不靥，脓汁不干，更多痛楚，若
不急治，渐成疳蚀，损伤筋骨，以致横夭，宜服十全大补汤，外敷救苦灭瘢散，或白龙散。
一、痘疮抓破去皮而犹有血水者，急用六气煎，或六物煎主之，外以白龙散敷之。
一、痘有臭气。凡当收靥之时，臭而带腥者，此痘疮成熟之气，邪气自内而出也，为吉。若臭
如烂肉浊恶不可近者，此虽似结痂，未可为真，急须清热滋血，宜凉血养营煎，或解毒防风汤。若
于养浆之时便见臭者，此毒火熏蒸之气，积于中而见于外也，大凶，速宜清热以解其毒。若痘疮溃
烂不靥而臭不可闻者，名为烂痘，间亦有收靥无事者。只要胃气不衰，饮食如故，不作烦躁，则为
可治，宜用八珍汤，或四味消毒饮，外用败草散敷之。
一、痘疮靥后而有生疮溃烂成坑者，须用托里消毒散，或解毒内托散主之。如气血俱虚而不敛
者，必用十全大补汤。如遍身疮多溃烂，深而无气血者必死。
痘疮进入化脓阶段后，脓液充盈、色泽肥润且质地坚实，用手触摸时，疮头坚硬且微微焦枯，这是即将结痂（靥）的征兆。结痂时若疮面干净，没有突起、凹陷、渗液或破裂，颜色呈苍蜡色，皮肤坚厚浓密，外表明亮而内部暗沉，疮顶尖锐刺手，这属于正常的结痂（正靥）。如果痘疮虽然看似干燥，但痂皮薄如纸张，或者体内仍有病邪未除，这是痘疮极其危险的时期，应当紧急进行调补，以免造成伤害。
一、痘疮从发出到第十日、第十一、十二日，应当从口唇、头部和面部开始逐渐收靂结痂。凡是自上而下消退的为顺证，自下而上消退的为逆证，如果发现其他兼证，应迅速治疗。
一、在即将结痂时，如果身体原本温度正常却突然发热，称为“干浆”，这也是常见的征候。此时不可轻易使用发汗或泻下的药物，如果有外感风寒，以及饮食损伤的情况，才应当根据具体证候进行治疗。
一、痘疮收靂结痂过迟，或者到了该结痂的时候不结痂，证候有几种情况，应当详细辨别并治疗。大部分该结痂却不结痂的病例，大多是因为脾胃虚弱，中气不足。因为中气虚则不能滋养肌肉，使其充实，也可能导致溃烂。只要观察没有其他兼证，而面色形态和气血都虚弱的，适宜内服十全大补汤，外用败草散衬垫。如果到了该结痂的时候不结痂，伴有轻微发热、脉象大而没有其他兼证的，这是阴分不足，适宜用四物汤加倍芍药、何首乌。如果血虚且热毒未清，适宜用四物汤加牛蒡子、木通、山楂。如果是因进食少导致脾胃气虚而不能收靂的，适宜用六气煎，或六物煎加减主治。如果频繁出现泄泻，脾胃弱，肌肉虚，形成腹胀、烦渴而不能收靂的，适宜用陈氏十二味异功散，或木香散，外用败草散敷贴。如果在该结痂的时候，忽然见到头面部温热，足趾冰冷，身体不热，或者泄泻腹胀，气促烦渴，应立即给予陈氏十二味异功散，或九味异功煎，延误时机则无法救治。凡是痘疮将要结痂时，出现泄泻、烦渴、腹胀咬齿等证候的，大多难以救治。如果喂食蜜水、生冷等食物，必定烦躁加重而死。有的因为饮水过多，或接触湿气，导致脾胃肌肉湿气浸淫，不能收靂难愈的，适宜用五苓散，或四苓散加山楂利湿。有的因为热毒未退，肌肤腠理郁蒸，阴气不能收敛而导致该结痂不结痂的，如果不迅速解除，毒邪必定内攻，危害不小，适宜用犀角散加芍药、牛蒡子。有内外俱热，阳毒散漫，导致大便秘结，阴气不通畅而导致该结痂不结痂的，适宜内服四顺清凉饮，或三黄丸以通便，外用败草散、猪胆导法。有因天气寒冷失于覆盖，疮面受寒凝滞而不能收靂的，适宜服用五积散，外用乳香，或芸香在被褥内熏蒸。有因天气炎热过暖，痘疮被热气蒸腾而不能收靂的，适宜内服人参白虎汤，或五苓散、四苓散以利湿热，外用天水散扑撒。有为邪秽阴寒所触犯，导致元气受损而不结痂的，适宜用保元汤，或十二味异功散，外用辟邪丹熏蒸，猪髓膏涂抹即可痊愈。
一、痘疮内热，毒邪未尽化解而结痂过快的，后来必然发生眼疾，成为痈毒，以及各种怪异证候，适宜用凉血养营煎稍微清降其火；如果大便过于干结的，适宜轻微通便以解其毒，用当归丸主治。
一、痘疮有脓液并结痂则为吉兆，无脓液而结痂则为凶兆，对此治疗不可迟缓。如果痘疮已经成脓，不能结痂，反而导致溃烂，或与皮肤一起脱落，这名叫“倒靥”，是毒瓦斯进入体内了，必须紧急大补中气以托举毒邪外出，适宜用六气煎加倍芍药，及紫草、防风、白芷主治；如果兼有湿热的，适宜用六气煎加芍药合四苓散主治。如果头面部疮破，服用补药后，只是重新肿胀重新灌脓，或者遍身无疮处又发出一层，叫做“补空”，虽然过期延日但饮食不减，不算大害。如果服药后不起不发不补充，这是毒邪已深入，是最凶险的征候。
一、痘疮无论是否溃破，在第十二日之后，只要能结痂，就是好兆头。如果痂皮不结，则必然形成倒靥。其中有回退未尽的，或者遍身都已结痂但只有几颗不结痂的，最终会导致瘙痒抓破，也难以保证生存，应当迅速治疗。
一、结痂时颜色白如梅花片状的，这叫假回（假性恢复），十二日后会死亡，这是不治之症。如果不泄泻，可迅速用六气煎，或六物煎，合二仙散大力进服以抢救。
一、痘疮成脓不结痂，以致溃烂，脓汁淋漓，粘着疼痛，不能接触席子的，用败草散，或荞麦散，用绢袋盛装扑撒在上面，更多地在席子上铺设衬垫睡觉尤其好，或者用秘传茶叶方也很好。如果想脸上不留疤痕的，用救苦灭瘢散，用蜜水调匀敷贴。
一、痘疮溃烂先从面部开始的，是凶兆。如果饮食无阻，大小便正常，更无其他兼证的，适宜内服十全大补汤。如果毒盛内热严重的，适宜用解毒防风汤加当归、蝉蜕，交替服用，外用救苦灭瘢散敷贴。
一、痘疮在未化脓之前，或者已经受伤破烂成疮，以及诸痘收靂时，唯独这一颗不结痂，脓汁不干，更多痛楚，如果不紧急治疗，逐渐形成疳蚀，损伤筋骨，以致横死，适宜服用十全大补汤，外敷救苦灭瘢散，或白龙散。
一、痘疮被抓破去皮而还有血水的，紧急用六气煎，或六物煎主治，外用白龙散敷贴。
一、痘疮有臭气。凡是在收靂的时候，臭中带腥味的，这是痘疮成熟的气，邪气从内向外排出，为吉兆。如果臭如烂肉浊恶不可靠近的，这虽然看似结痂，并非真正愈合，必须紧急清热滋血，适宜用凉血养营煎，或解毒防风汤。如果在养浆的时候便见臭气的，这是毒火熏蒸之气，积聚在中焦而表现于外，大凶，速宜清热以解其毒。如果痘疮溃烂不结痂且臭不可闻的，名叫烂痘，间或有收靂无事者。只要胃气不衰，饮食如常，不作烦躁，则为可治，适宜用八珍汤，或四味消毒饮，外用败草散敷贴。
一、痘疮结痂后而有生疮溃烂成坑的，须用托里消毒散，或解毒内托散主治。如果气血俱虚而不能收敛的，必须用十全大补汤。如果遍身疮多溃烂，深而无气血的必死。
After the smallpox pustules have filled with pus, they are plump, lustrous, and firm. Upon palpation, the pustule heads are hard and slightly scorched, indicating that scabbing (jieye) is about to occur. If the scabbing process is clean, without protrusions, depressions, excessive exudate, or rupture, and the color is waxy grayish-green, the skin is thick and dense, bright on the outside but dark inside, with sharp points that irritate the finger, this is considered normal scabbing (zhengye). However, if the pustules appear dry but the crusts are thin as paper, or if internal pathogenic factors remain unresolved, this represents an extremely critical stage of smallpox. Immediate regulation and tonification are necessary to prevent harm.
1. From the onset until the tenth, eleventh, or twelfth day, the smallpox lesions should gradually resolve and scab starting from the lips, head, and face. Resolution proceeding from top to bottom is a favorable progression (shun), while resolution proceeding from bottom to top is unfavorable (ni). If other symptoms are observed, they must be treated promptly.
2. During the impending scabbing phase, if the body temperature, which was previously normal, suddenly rises, it is termed "dry paste" (ganjiang), which is also a common occurrence. At this time, diaphoretic or purgative therapies should not be used lightly. Only in cases of external contraction of wind-cold or dietary injury should treatment be administered according to the specific syndrome.
3. Delayed scabbing or failure to scab when expected presents several syndromes that require detailed differentiation and treatment. Most cases of delayed scabbing are due to weak spleen-stomach function and deficiency of middle qi. Since middle qi deficiency fails to nourish muscles to make them solid, it may also lead to ulceration. If no other symptoms are present and the complexion, form, and qi-blood are all deficient, Shiquan Dabu Tang (Complete Great Tonifying Decoction) should be taken internally, and Baicao San (Decayed Grass Powder) applied externally as a lining. If scabbing fails to occur accompanied by slight fever and a large pulse without other symptoms, this indicates insufficiency of the yin aspect; Siwu Tang (Four Substances Decoction) with increased amounts of Shaoyao (Paeoniae Radix) and Heshouwu (Polygoni Multiflori Radix) is indicated. If blood deficiency and heat-toxin are unclarified, Siwu Tang added with Niubangzi (Arctii Fructus), Mutong (Akebiae Caulis), and Shanzha (Crataegi Fructus) is appropriate. If failure to scab results from poor appetite and spleen-stomach qi deficiency, Liuqi Jian (Six Qi Decoction) or Liuwu Jian (Six Substances Decoction) with modifications is indicated. If frequent diarrhea occurs alongside weak spleen-stomach, vacuous muscles, abdominal distension, and vexatious thirst preventing scabbing, Chen's Shi'erwei Yigong San (Twelve-Ingredient Extraordinary Merit Powder) or Muxiang San (Costus Root Powder) should be used, with Baicao San applied externally. If, during the scabbing period, the head and face become warm while the toes are cold, the body is not hot, or diarrhea, abdominal distension, shortness of breath, and vexatious thirst appear, Chen's Shi'erwei Yigong San or Jiawei Yigong Jian (Nine-Ingredient Extraordinary Merit Decoction) must be administered immediately; delay renders the condition incurable. Smallpox cases presenting diarrhea, vexatious thirst, abdominal distension, and teeth grinding during the impending scabbing phase are often incurable. Administration of honey water or raw/cold foods will inevitably lead to aggravated restlessness and death. Cases caused by excessive water intake or exposure to dampness, leading to dampness inundating the spleen-stomach and muscles and preventing scabbing, should be treated with Wuling San (Five-Ingredient Powder with Poria) or Siling San (Four-Ingredient Powder with Poria) added with Shanzha to promote diuresis. Cases where heat-toxin has not subsided, causing stagnation and steaming in the skin and pores, preventing yin from consolidating and thus hindering scabbing, require rapid resolution; otherwise, toxin will attack inward causing significant harm. Xijiao San (Rhinoceros Horn Powder) added with Shaoyao and Niubangzi is indicated. In cases of internal and external heat, scattered yang-toxin, constipation, and blocked yin qi preventing scabbing, Sishun Qingliang Yin (Four-Obedience Cooling Clearing Decoction) or Sanhuang Wan (Three-Yellow Pill) should be taken internally to unblock bowels, while Baicao San and pig gallbladder enema methods are used externally. If cold weather leads to lack of covering, causing cold coagulation in the sores and preventing scabbing, Wuji San (Five Accumulations Powder) is indicated, with Rushxiang (Frankincense) or Yunxiang (Dill Fruit) smoked within bedding externally. If excessive heat from warm weather causes steaming of the pustules preventing scabbing, Renshen Baihu Tang (Ginseng White Tiger Decoction) or Wuling San/Siling San should be taken internally to drain damp-heat, and Tianshui San (Heavenly Water Powder) applied externally. If touched by evil filth and yin-cold, damaging yuan qi and preventing scabbing, Baoyuan Tang (Preserve Origin Decoction) or Shi'erwei Yigong San is indicated, with Pixie Dan (Evil-Repelling Pill) smoked externally and Zhuisui Gao (Pig Marrow Ointment) applied.
4. If internal heat in smallpox remains and toxin is not fully transformed, resulting in too rapid scabbing, eye diseases, carbuncles/toxins, and various strange syndromes will likely follow later. Liangxue Yangying Jian (Cool Blood Nourish Ying Decoction) should be used to slightly clear the fire. If stools are excessively dry and bound, mild purgation is needed to resolve toxin, using Danggui Wan (Angelica Sinensis Pill).
5. Smallpox with pus formation and subsequent scabbing is auspicious; scabbing without pus is ominous. Treatment cannot be delayed. If pustules have formed pus but fail to scab, instead becoming ulcerated or detaching with the skin, this is called "reverse scabbing" (daoye), indicating toxin entering the interior. Urgent major tonification of middle qi to support the interior is required, using Liuqi Jian with doubled Shaoyao, plus Zicao (Lithospermi Radix), Fangfeng (Saposhnikoviae Radix), and Baizhi (Angelicae Dahuricae Radix). If damp-heat is concurrent, Liuqi Jian added with Shaoyao combined with Siling San is indicated. If facial sores break and, after taking tonic medicines, swell and refill again, or if a new layer erupts on areas without sores, this is called "filling empty spaces" (bukong). Although prolonged, if diet remains unchanged, it is not a major harm. If, after medication, there is no rise, filling, or replenishment, the toxin has penetrated deeply, representing the most ominous prognosis.
6. Regardless of whether sores have ulcerated, if scabbing occurs after the twelfth day, it is a good omen. If crusts do not form, reverse scabbing will result. If resolution is incomplete, or if the whole body has scabbed except for a few spots, itching and scratching may eventually cause rupture, making survival uncertain. Prompt treatment is essential.
7. If the color during scabbing is white like plum blossom petals, this is "false return" (jiahui). Death will occur after twelve days; this is an untreatable syndrome. If there is no diarrhea, Liuqi Jian or Liuwu Jian combined with Erxian San (Two Immortals Powder) should be administered vigorously for rescue.
8. For smallpox that fails to scab after pus formation, leading to ulceration, dripping pus, sticking pain, and inability to lie on mats, use Baicao San or Qiaomai San (Buckwheat Powder) contained in silk bags for application. Laying more cloth on the mat for lying is even better. The secret tea prescription is also effective. To prevent facial scarring, Jiuku Mieban San (Save Life Remove Scar Powder) mixed with honey water should be applied.
9. Ulceration of smallpox starting on the face is an ominous sign. If there is no obstruction to eating/drinking, bowel/bladder functions are normal, and no other symptoms exist, Shiquan Dabu Tang is indicated internally. If toxin is severe with internal heat, Jiedu Fangfeng Tang (Detoxify Wind-Barrier Decoction) added with Danggui and Chantui (Cicada Slough) should be taken alternately, with Jiuku Mieban San applied externally.
10. Before pus formation, or if a sore becomes broken/ulcerated due to injury, or if other sores scab while this one does not, with non-drying pus and increased pain, failure to treat urgently will lead to gan erosion, damage to sinews and bones, and premature death. Shiquan Dabu Tang should be taken, with Jiuku Mieban San or Bailing San (White Dragon Powder) applied externally.
11. If smallpox is scratched open, skin removed, but blood and fluid remain, Liuqi Jian or Liuwu Jian should be used urgently, with Bailing San applied externally.
12. Odor in smallpox: During scabbing, a smell that is foul yet fishy indicates mature smallpox qi, with evil qi exiting from within; this is auspicious. A smell like rotting meat, turbid and repulsive, suggests apparent but false scabbing; urgent clearing of heat and nourishing of blood is required, using Liangxue Yangying Jian or Jiedu Fangfeng Tang. If odor appears during the "nourishing paste" phase, it indicates toxic fire steaming, accumulating in the center and manifesting externally; this is highly ominous, requiring rapid heat-clearing to resolve toxin. If smallpox is ulcerated, does not scab, and emits unbearable stench, it is named "rotten smallpox" (landou). Some cases resolve without issue. As long as stomach qi is not exhausted, diet is normal, and there is no vexation/restlessness, it is treatable. Bazhen Tang (Eight-Treasure Decoction) or Simiao Xiaodu Yin (Four-Ingredient Detoxifying Decoction) is indicated, with Baicao San applied externally.
13. If smallpox develops new sores and ulcers forming pits after scabbing, Tuoli Xiaodu San (Support Interior Detoxify Powder) or Jiedu Neituo San (Detoxify Support Interior Powder) should be used. If qi and blood are both deficient and unable to converge, Shiquan Dabu Tang is mandatory. If the entire body has numerous deep ulcers lacking qi and blood, death is inevitable.