【瘢赤黑】〔万〕疮痂落后，其面瘢或赤或黑者，用四白灭瘢散，临睡以清蜜水
调搽面上，至晓以水涤去之，自然白莹，脱去更宜爱护，不得早见风日，经年不灭。如疮瘢突起成凸者，此热毒未
尽，解毒防风汤主之（见形发热），外更用蚬子内水摩之。如陷下成凹者，此脾胃虚不能长肌肉也，人参白术散（痘渴）
加黄 主之。
四白灭瘢散
白芷 白附子 白僵蚕 鹰矢 白密陀僧（各等分）
共研极细末。以水调搽面 ，神效。
韶粉散 治痘疮才愈，毒瓦斯未尽，疮痂虽落，其瘢犹黯，或凸凹肉起，当用此药涂之。
韶粉（一两） 轻粉（一钱）
上研细末。猪骨髓熬熟调成膏，薄涂疮瘢上。如痘疹欲落，当灭瘢痕，一名灭瘢散。
【瘢黑暗】凡疮瘢头面浑身并黑暗者，未可便说无事，犹恐日前未甚作脓，收靥太急，此倒靥归肾也。但察其表里，
如壮热大渴未除，烦闷昏睡少食，或大便不通，或自利，此真倒靥归肾也，若身温暖爽快，食渐加，大小便调者，
此疮瘢本色，无虑也。
【痂不脱】〔万〕痘疮收后，其痂自脱者佳，不脱，以百花膏润之，令其速脱，稍迟则干硬，深入肌肉，经久方脱，
遂成瘢痕。然久而不脱者，脾胃虚也，人参白术散加黄 、官桂主之，不可 掐剥去，若不禁手，反伤皮肤，
复灌作疮，番覆溃烂，一时难愈，其后多成疥癞也。〔黄〕痘疮粘着皮肉，不肯脱落，此表虚也，尤
当禁忌，以防异变，用调元固表汤主之。
调元固表汤
黄 人参 当归 甘草 蝉蜕
人参固肌汤 治痘表发太过，致肌肉不密，痘痂粘肉，久不落者。
人参 黄 甘草 当归 蝉蜕（各等分） 糯米（一撮）
上，用水煎服。
人参清神汤 治痘痂不落，昏迷沉睡者。
人参 黄 甘草 当归 白术（土炒） 麦门冬 陈皮 酸枣仁 黄连（酒炒） 茯苓
上，各等分，加枣子、糯米，水煎服。
马齿苋散 治痘痂不落，成 痕者。
马齿苋（捣汁） 猪脂膏 石蜜
三味共熬成膏，涂肿处。
凡疮痂日久，当脱不脱者，胸背手足无妨，惟面上不脱，必成瘢陷，未脱者以
百花膏润之（收靥），令其易脱，脱尽之后，瘢痕黑黯者，以四白灭瘢散涂之。
羊 骨髓 治痘痂欲落不落，瘢痕。
羊 骨髓一两，炼入轻粉一钱，研成膏，涂之。
如收靥既迟，疮痂不落，昏昏喜睡者，此邪气已退，正气未复，脾胃虚弱，宜调元汤（即参 饮见
大法）加麦门冬，合安神丸（痘烦躁）。或只用酸枣仁汤（烦躁）缓缓调理，待气血平复，荣卫和畅而安矣。
【瘢肿成脓】痘疮收靥之后，痂皮尽脱，曾见瘢痕凸起，复作脓窠，依旧结一层 子者，或因收靥太
骤，毒瓦斯未尽，或因误服温补之药，多啖肥甘之物，饮酒喜食煎炒辛热，或因出风太早，荣卫郁而不通，皆
能复成此证，亦与前日一般，但无苦耳，若此者，毒邪外散，决无留毒之患。痘疮遍身溃烂不结痂者，倒靥也。或三
五处肿灌溃烂，不结痂者，疳蚀疮也。若已正靥，痂起自脱。或面上，或手足，或片结硬疮，头虽焦，中蓄脓浆者，
此是原出疮子之初，其处太密，糊涂成片，无复颗粒，所以毒壅于里，不能起发作脓结痂也，但用灭瘢救苦散（收靥）
和百花膏（收靥）涂之，待脓尽痂起自愈。或手足腕膝之间，疮窠连串作大一块，脓化作水，停蓄于中，恰
如囊袋，皮不破，水不去，日久只如是者，此里面肌肉已好，原日疮皮、剩于外也，宜用针决去其水，自干脱矣。
【能食不能食】疮痂既落，中气暴虚，多不能食，必藉人参白术散去葛根，加陈皮、木香、以调养之。其间或有疮
痂起而能食者，是胃中宿有蕴热故也，盖胃热则消谷，所以能食，其人必大便稍秘，或大便难，当用三黄丸利之，
否则恐胃热不去，郁为口臭，齿腐生风之证，流散四肢，则发为痈疽肿毒。然有一等脾胃素壮
实者，平素能食，大便亦不至有秘结之患，此又不可一概论也。
【瘢痕赤白】痘痕赤白，各有所因，治法亦异。凡痕赤而作痒，血虚而有热也，
用四味牡丹皮。赤而作痛，余热也，用四君、连翘、金银花。若发热而大便调和者，
脾胃虚热也，用五味异功散。若发热而大便秘结者，肠胃内热也，用《圣济》犀角地黄汤。若母有肝火，用加味
逍遥散。若母有郁怒，用加味归脾汤，佐以加味逍遥散治之。白者 属气虚而血衰也，宜固元气为本。痒而作渴者，
气血俱虚也，十全大补汤之类。乳食减少，四肢倦怠者，中气虚也，五味异功散之类。气虚发热者，
补中益气汤之类。血虚发热者，当归补血汤之类。须参兼变之证治之。此证若服药而渐红活者可治，色不转者不治，
虽经年后多患泻利而死，若妄投攻伐，祸在反掌。一小儿痘疮如期而愈，痕赤如赭。余谓此乳母有热也，诊之，果
有肝脾郁火，先用加味逍遥散四剂，与母服之，子各饮少许而并愈。一小儿痘痕色赤作痛，热渴喜
冷，大便不利。先用前胡枳壳散，便利渴止，再用《圣济》犀角地黄汤而安，又用芹菜汁而靥。一小儿十六岁，痘痕白，
用独参汤数斤，色渐如旧，又用地黄丸、大补汤、而安。
【禁忌】痘疮新瘥之后，气血未复，视之未靥，尤加调护可也。盖痂皮起落，肌肉新嫩，不宜澡洗，增减衣服则表
已虚，寒暑之气易袭也。疮毒内作，脏腑俱伤，毒虽外散，肠胃已弱，不宜饮冷，伤饥过饱则里气虚，饮食之物易
伤也，时俗不知此理，谓之已痊，再无他变，怠玩纵弛，致生后灾，一旦病生，悔之晚矣。
【 杌痘】〔袁〕按∶孙氏揭 杌痘以垂世，而不注解其详，迨黄石峰尽注明白。且痘澄脓结痂，自头抵足，
靥已脱矣，又身发火热，旧靥盆处，重出一番痘，疏囊聚脓，痛愈加甚，服药调护，庶免夭亡，倘饮食不节，风寒不
避，邪气感迫，囊破溃烂，肚腹渐胀，阴阳不分，死在旦夕矣。若起于头面者，须防陋井涌泉（陋井、腮颊穿陋，
涌泉、眼沿陋）。之患，起于背腹者，应虑蜂螫沉石之虑（蜂螫，遍身刺痛也，沉石，皮肉四烂也），起于手足者，
不免有罄笔之罹，起于阳球者，预宜防脱囊之害。玉函云∶天花结果庆奇全， 杌归门痘倒颠，不是渠塘番汹浪，
便教关节结痈缠。为父母者，庶几慎之。
【瘢痕呈赤黑色】〔万全〕痘疮结痂脱落后，面部的瘢痕有的发红、有的发黑，使用四白灭瘢散，睡前用清蜜水调和涂抹于面部，次日清晨用水洗净，自然变得洁白晶莹。痂皮脱落后更应注意爱护，不要过早接触风日，即使经过一年瘢痕不消退也不必担心。如果疮疤突起形成凸起，这是热毒未尽，主用解毒防风汤治疗（参见“形发热”章节），外用蚬子内水摩擦患处。如果凹陷成坑，这是脾胃虚弱不能生肌长肉，用人参白术散（参见“痘渴”章节）加黄芪主治。
四白灭瘢散
白芷 白附子 白僵蚕 鹰矢石 白密陀僧（各等分）
共研成极细粉末。用水调和涂抹面部，效果神奇。
韶粉散 治疗痘疮刚刚痊愈，毒气未尽，疮痂虽然脱落，但瘢痕仍然暗淡，或凹凸不平、肌肉隆起，应当使用此药涂抹。
韶粉（一两） 轻粉（一钱）
以上研成细末。用猪骨髓熬熟调成膏状，薄涂于疮瘢上。如果痘疹即将脱落，想要消除瘢痕，又名灭瘢散。
【瘢痕黑暗】凡是疮疤在头面及全身都呈现黑色的，不可以轻易说没事，恐怕是因为前几天化脓不充分，收靥（结痂脱落）太快，这是倒靥归肾的表现。只要观察其表里情况，如壮热大渴未除，烦闷昏睡、食欲减少，或者大便不通，或者自利腹泻，这是真正的倒靥归肾；如果身体温暖爽快，饮食逐渐增加，大小便正常，这是疮疤的本色，无需忧虑。
【痂皮不脱落】〔万全〕痘疮收敛后，痂皮自然脱落为佳，如果不脱落，用百花膏滋润它，使其快速脱落，稍晚则变干硬，深入肌肉，经久才脱落，最终形成瘢痕。然而久拖不脱的，是脾胃虚弱，用人参白术散加黄芪、官桂主治，不可用手掐剥去除，如果忍不住手去抠剥，反而损伤皮肤，再次感染化脓，反复溃烂，一时难以愈合，其后多变成疥癞之症。〔黄〕痘疮粘着皮肉，不肯脱落，这是表虚，尤其应当禁忌（指避免不当处理），以防发生异变，用调元固表汤主治。
人参固肌汤 治疗痘表发散太过，导致肌肉不致密，痘痂粘肉，久久不落者。
人参 黄芪 甘草 当归 蝉蜕（各等分） 糯米（一撮）
以上，用水煎服。
人参清神汤 治疗痘痂不落，昏迷沉睡者。
人参 黄芪 甘草 当归 白术（土炒） 麦门冬 陈皮 酸枣仁 黄连（酒炒） 茯苓
以上，各等分，加枣子、糯米，水煎服。
马齿苋散 治疗痘痂不落，形成肿胀痕迹者。
马齿苋（捣汁） 猪脂膏 石蜜
三味共同熬成膏状，涂于肿处。
凡是疮痂日子久了，应当脱落却不脱落的，胸背手足无妨，只有脸上不脱，必然形成凹陷瘢痕，未脱落的用百花膏滋润（用于收靥阶段），使其容易脱落，脱尽之后，如果瘢痕黑黯，用四白灭瘢散涂抹。
羊骨髓 治疗痘痂欲落不落，遗留瘢痕。
羊骨髓一两，炼入轻粉一钱，研成膏，涂抹患处。
如果收靥既迟，疮痂不落，昏昏喜睡，这是邪气已退，正气未复，脾胃虚弱，宜用调元汤（即参苓饮，见大法章节）加麦门冬，合安神丸（用于痘烦躁）。或者只用酸枣仁汤（用于烦躁）缓缓调理，待气血平复，营卫和畅而安。
【瘢痕肿而成脓】痘疮收靥之后，痂皮全部脱落，曾见到瘢痕凸起，又化作脓窠，依旧结一层痂子的，可能是因为收靥太急骤，毒气未尽，或者误服温补药物，多吃肥甘厚味之物，饮酒喜好食用煎炒辛热食物，或者因为出风太早，营卫郁滞不通，都能再次形成此证，也与前日一般，只是没有痛苦罢了，如果是这种情况，毒邪向外散发，决不会有留毒的祸患。痘疮遍身溃烂不结痂的，是倒靥。或者三五处肿胀灌脓溃烂，不结痂的，是疳蚀疮。如果已经正靥，痂皮自行脱落。或者在脸上，或在手足，或成片结成硬疮，头部虽焦枯，中间蓄积脓浆的，这是因为原发出痘之初，该处太密集，糊涂成片，不再有颗粒，所以毒气壅塞在内部，不能起发作脓结痂，只需用灭瘢救苦散（用于收靥）和百花膏（用于收靥）涂抹，待脓尽痂起自愈。或者在手足腕膝之间，疮窠连串作一大块，脓化作水，停蓄其中，恰如囊袋，皮不破，水不去，日子久了只是这样，这是里面肌肉已经好了，原来的疮皮剩在外面，宜用针刺破排出积水，自然会干燥脱落。
【能食与不能食】疮痂既已脱落，中气突然虚弱，大多不能进食，必须借助人参白术散去葛根，加陈皮、木香来调养。其间或有疮痂起了却能进食的，是胃中宿有蕴热所致，因为胃热则消谷善饥，所以能进食，其人必定大便稍秘结，或者大便困难，当用三黄丸通利大便，否则恐怕胃热不去，郁积成为口臭、牙齿腐烂生风之证，流散四肢，则发为痈疽肿毒。然而有一类脾胃素来强壮结实的人，平时能进食，大便也不至于有秘结的隐患，这又不可一概而论。
【瘢痕赤白】痘痕赤白，各有原因，治法也不同。凡是痕赤且发痒，是血虚而有热，用四味牡丹皮。赤且疼痛，是余热，用四君子汤、连翘、金银花。如果发热而大便调和，是脾胃虚热，用五味异功散。如果发热而大便秘结，是肠胃内热，用《圣济总录》犀角地黄汤。如果母亲有肝火，用加味逍遥散。如果母亲有郁怒，用加味归脾汤，佐以加味逍遥散治疗。白色属于气虚而血衰，宜以固元气为本。痒而且口渴，是气血俱虚，用十全大补汤之类。乳食减少，四肢倦怠，是中气虚，用五味异功散之类。气虚发热，用补中益气汤之类。血虚发热，用当归补血汤之类。须参考兼夹变化的证候进行治疗。此证如果服药后渐渐红活的可治，颜色不转变的不治，虽然经过多年也多因患泻利而死，如果妄投攻伐药物，祸患就在反掌之间。一个小孩痘疮如期痊愈，痕赤如赭石色。我认为这是乳母有热，诊察发现果然有肝脾郁火，先用加味逍遥散四剂，给母亲服用，孩子也喝少许，一同痊愈。一个小孩痘痕色赤作痛，热渴喜冷，大便不利。先用前胡枳壳散，便利渴止，再用《圣济总录》犀角地黄汤而安，又用芹菜汁而结痂。一个十六岁的小孩，痘痕白，用独参汤数斤，颜色渐渐恢复旧观，又用地黄丸、大补汤，而安。
【禁忌】痘疮新愈之后，气血未复，视之尚未完全收靥，尤其要加强调护。因为痂皮起落，肌肉新嫩，不宜洗澡清洗，增减衣服则体表已虚，寒暑之气容易侵袭。疮毒在内作祟，脏腑俱伤，毒虽向外散发，肠胃已弱，不宜饮冷，受饥过饱则里气虚，饮食之物容易受伤，世俗之人不知此理，称为已经痊愈，再无其他变故，怠慢放纵，导致后患，一旦生病，后悔就晚了。
【杌痘】〔袁〕按：孙氏揭示杌痘以流传于世，而不注解其详细情况，等到黄石峰完全注明明白。且痘澄脓结痂，从头到脚，靥已脱落，又身体发火热，旧靥盆处，重新发出一番痘，疏囊聚脓，疼痛更加严重，服药调护，或许可以避免夭亡，倘若饮食不节，风寒不避，邪气感迫，囊破溃烂，肚腹渐胀，阴阳不分，死在旦夕了。如果起于头面的，须防陋井涌泉（陋井，指腮颊穿陋；涌泉，指眼沿穿陋）的祸患，起于背腹的，应虑蜂螫沉石之虑（蜂螫，指遍身刺痛；沉石，指皮肉四烂），起于手足的，不免有罄笔之罹（形容惨状写不尽），起于阳球（睾丸）的，预宜防脱囊之害。玉函云：“天花结果庆奇全，杌归门痘倒颠，不是渠塘番汹浪，便教关节结痈缠。”做父母的，应该谨慎对待。
[Scar Reddish-Black] [Wan Quans] After the scabs of smallpox fall off, the scars on the face may be either red or black. Use Sibai Mieban San (Four Whites Scar-Removing Powder) mixed with clear honey water to apply to the face before sleep. Wash it off with water at dawn; the skin will naturally become white and lustrous. After the scabs fall off, extra care should be taken to avoid exposure to wind and sunlight for a long time. Even if the scar does not fade after a year, there is no need to worry. If the scar protrudes and forms a convex shape, this indicates that heat-toxin has not been fully cleared. The main prescription is Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) (see "Shape Fever" chapter). Externally, apply water from inside clam shells by rubbing. If the scar is depressed and concave, this is due to Spleen-Stomach deficiency failing to generate flesh. The main prescription is Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Decoction) (see "Smallpox Thirst" chapter) added with Huangqi (Astragalus Root).
Sibai Mieban San (Four Whites Scar-Removing Powder)
Baizhi (Angelicae Dahuricae Radix), Baifuzi (Aconiti Kusnezoffii Radix), Baijiangcan (Bombyx Batryticatus), Yingshishi (Avian Feces), Baimotuoseng (Lithargyrum) in equal parts.
Grind into an extremely fine powder. Mix with water and apply to the face; it is miraculous.
Shaofen San (Pearl Powder Powder) Treats cases where smallpox has just healed, but toxin remains. Although scabs have fallen, scars remain dark, or uneven with raised flesh. Apply this medicine externally.
Shaofen (Pearl Powder, 1 liang), Qingfen (Calomel, 1 qian).
Grind into a fine powder. Cook pig marrow and mix into a paste. Apply thinly to the scars. If smallpox vesicles are about to fall and one wishes to remove scars, it is also called Mieban San (Scar-Removing Powder).
[Dark Scars] Whenever scars on the head, face, and whole body appear dark/black, do not casually assume there is no problem. It is feared that previously pus formation was insufficient and the crusts fell too quickly, indicating "Dao Ye Gui Shen" (Inverted Crusting Returning to Kidney). Observe the exterior and interior conditions: if there is high fever and severe thirst unrelieved, restlessness, drowsiness, poor appetite, constipation, or spontaneous diarrhea, this is true "Dao Ye Gui Shen". If the body feels warm and comfortable, appetite gradually increases, and bowel/bladder movements are normal, these are the natural colors of the scars, and there is no cause for concern.
[Scabs Not Falling Off] [Wan Quans] After smallpox收敛 (converges/heals), it is auspicious if scabs fall off naturally. If they do not, use Baihua Gao (Hundred Flowers Ointment) to moisten them, allowing them to fall off quickly. If delayed, they become dry and hard, penetrating deep into the muscle, taking a long time to fall off, eventually forming scars. However, scabs that linger are due to Spleen-Stomach deficiency. The main prescription is Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Decoction) added with Huangqi (Astragalus Root) and Guigui (Cinnamon Twig). Do not pick or peel them off with hands; if one cannot resist touching, it will damage the skin, leading to reinfection and suppuration, repeated ulceration, which is difficult to heal in a short time, often resulting in scabies-like conditions later. [Huang] Smallpox scabs adhering to the skin and refusing to fall off indicate Exterior Deficiency. One must strictly observe taboos to prevent abnormal changes. The main prescription is Tiaoyuan Gabiao Tang (Regulating Origin and Consolidating Exterior Decoction).
Tiaoyuan Gabiao Tang
Huangqi (Astragalus Root), Renshen (Ginseng Root), Danggui (Angelica Sinensis Radix), Gancao (Licorice Root), Chantui (Cicada Slough).
Renshen Guji Tang (Ginseng Muscle-Solidifying Decoction) Treats cases where smallpox eruption was excessive, causing loose muscle texture, making scabs adhere to flesh and fail to fall off for a long time.
Renshen (Ginseng Root), Huangqi (Astragalus Root), Gancao (Licorice Root), Danggui (Angelica Sinensis Radix), Chantui (Cicada Slough) in equal parts; Nuomi (Glutinous Rice, a pinch).
Decoct in water and take orally.
Renshen Qingshen Tang (Ginseng Spirit-Clearing Decoction) Treats cases where scabs do not fall off, accompanied by coma and deep sleep.
Renshen (Ginseng Root), Huangqi (Astragalus Root), Gancao (Licorice Root), Danggui (Angelica Sinensis Radix), Baizhu (Atractylodes Macrocephala Rhizome, stir-fried with soil), Maidong (Ophiopogon Tuber), Chenpi (Citrus Reticulata Pericarp), Suanzaoren (Ziziphus Seed), Huanglian (Coptis Rhizome, wine-fried), Fuling (Poria).
Equal parts, add dates and glutinous rice, decoct in water and take orally.
Machixian San (Purslane Powder) Treats cases where scabs do not fall off, forming swollen marks.
Machixian (Portulaca Oleracea, crushed for juice), Zhizhi Gao (Lard), Shimii (Rock Sugar).
Boil the three ingredients together into an ointment and apply to the swollen area.
Whenever scabs have been present for a long time and should fall off but do not, it is harmless on the chest, back, hands, and feet. Only on the face will failure to shed lead to depressed scars. Moisten the unshed scabs with Baihua Gao (Hundred Flowers Ointment) to facilitate shedding. After complete shedding, if scars are black and dull, apply Sibai Mieban San (Four Whites Scar-Removing Powder).
She Marrow Treats smallpox scabs that want to fall but do not, leaving scars.
She Marrow (1 liang), refined with Qingfen (Calomel, 1 qian), ground into an ointment, and applied.
If crusting is delayed, scabs do not fall off, and the patient is drowsy and sleepy, this indicates pathogenic qi has retreated but healthy qi has not yet recovered, and Spleen-Stomach is weak. Use Tiaoyuan Tang (i.e., Shenling Yin, see General Principles) added with Maidong (Ophiopogon Tuber), combined with Anshen Wan (Peaceful Spirit Pill, for smallpox irritability). Or simply use Suanzaoren Tang (Ziziphus Decoction, for irritability) for slow regulation. Wait until Qi and Blood are balanced and Ying-Wei (Nutritive and Defensive Qi) flow smoothly to achieve peace.
[Scar Swelling Suppurating] After smallpox crusting, when all scabs have fallen, sometimes scars protrude and turn into pustules, forming another layer of crust. This may be due to crusting being too rapid with residual toxin, or mistakenly taking warming and tonifying medicines, overeating rich and sweet foods, drinking alcohol, preferring fried and spicy foods, or exposing to wind too early, causing Ying-Wei stagnation. All can lead to this condition again. It is similar to previous stages but without pain. In such cases, toxin disperses outward, so there is no risk of retained toxin. Smallpox ulcers all over the body without crusting indicate "Dao Ye" (Inverted Crusting). Three or five areas swelling, suppurating, and ulcerating without crusting indicate "Gan Shi Chuang" (Keratotic Ulcer). If normal crusting has occurred and scabs fall off naturally, whether on the face, hands, feet, or forming hard patches, even if the head is scorched but pus accumulates inside, this is because the original eruption was too dense, merging into a mass without distinct grains, causing toxin congestion internally, preventing pus formation and crusting. Use Miebian Jiuku San (Scar-Removing and Bitterness-Saving Powder) mixed with Baihua Gao (Hundred Flowers Ointment) to apply. Wait for pus to drain and scabs to rise for self-healing. Between wrists and knees, if pustules connect into a large mass, turning to fluid and accumulating like a bag without breaking the skin, and persisting for a long time, this indicates internal muscles have healed, and only the old skin remains outside. Puncture with a needle to drain the fluid, and it will dry and fall off naturally.
[Eating Ability] After scabs fall off, Middle Qi suddenly becomes deficient, and most patients cannot eat. One must rely on Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Decoction) removing Gegen (Pueraria Lobata Root), adding Chenpi (Citrus Reticulata Pericarp) and Muxiang (Aucklandia Root) for nourishment. Occasionally, some patients can eat despite new scabs; this is due to latent heat in the Stomach. Stomach heat promotes digestion, hence the ability to eat. These patients usually have slightly constipated stools or difficulty defecating. Use Sanhuang Wan (Three Yellows Pill) to purgatively clear heat. Otherwise, Stomach heat may accumulate, causing bad breath, rotting teeth, and wind syndromes, spreading to limbs and causing carbuncles and toxic swellings. However, those with inherently strong Spleen-Stomach constitution who normally eat well and have regular bowels are exceptions and should not be generalized.
[Red and White Scars] Red and white smallpox scars have different causes and treatments. Red scars with itching indicate Blood Deficiency with Heat; use Siwei Mudan Pi (Four Ingredients of Tree Peony Bark). Red scars with pain indicate residual heat; use Sijunzi Tang (Four Gentlemen Decoction), Lianqiao (Forsythia Fruit), and Jinyinhua (Honeysuckle Flower). If fever is present with normal stools, it is Spleen-Stomach Deficient Heat; use Wuwei Yigong San (Five Ingredient Meritorious Service Powder). If fever is present with constipation, it is Intestinal-Stomach Internal Heat; use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) from *Shengji Zonglu*. If the mother has Liver Fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If the mother has depression and anger, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction), assisted by Jiawei Xiaoyao San. White scars belong to Qi Deficiency and Blood Decline; solidify Yuan Qi as the root. Itching with thirst indicates Qi and Blood both deficient; use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction). Reduced milk/food intake and limb fatigue indicate Middle Qi Deficiency; use Wuwei Yigong San (Five Ingredient Meritorious Service Powder). Qi Deficiency causing fever: Buyi Zhongyi Tang (Tonify the Middle and Augment the Qi Decoction). Blood Deficiency causing fever: Danggui Buxue Tang (Angelica Tonify Blood Decoction). Treatment must consider concurrent and varying symptoms. If the scar turns reddish and lively after medication, it is treatable; if color does not change, it is untreatable, and death from diarrhea may occur years later. Reckless use of attacking drugs brings disaster instantly. A child's smallpox healed on schedule, leaving red scars like ochre. I reasoned this was due to maternal heat. Diagnosis confirmed Liver-Spleen Depressed Fire. First, gave Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for four doses to the mother, and a little to the child; both recovered. Another child had red, painful scars, fever, thirst, preference for cold drinks, and constipation. First used Qianhu Zhike San (Peucedanum and Aurantium Powder); once bowels moved and thirst stopped, used Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) to stabilize, then Celery Juice to form crusts. A sixteen-year-old child had white scars. Used Dushen Tang (Single Ginseng Decoction) for several jin; color gradually returned to normal. Then used Dihuang Wan (Rehmannia Pill) and Dabu Tang (Great Tonifying Decoction) to recover.
[Taboos] After recent recovery from smallpox, Qi and Blood are not yet restored, and crusting is incomplete. Extra care is essential. As scabs rise and fall, new muscle tissue is tender. Bathing is inadvisable. Changing clothes exposes the weakened exterior to Cold and Summerheat pathogens. Pathogenic toxins act internally, damaging Zang-Fu organs. Although toxin disperses outward, the Intestines and Stomach are weak. Cold drinks are prohibited. Hunger or overeating damages Interior Qi and makes food hard to digest. Laypeople ignore this, thinking recovery is complete with no further risks. Negligence leads to later disasters. Once illness strikes, it is too late to regret.
[Wu Dou (Stumbling Smallpox)] [Yuan] Note: Sun Shi revealed Wu Dou for posterity but did not annotate details in depth. Later, Huang Shifeng clarified everything. When smallpox pus clears and scabs form from head to toe, and crusts have fallen, yet the body develops fever and heat, and a new round of smallpox erupts at the site of old crusts, with sparse sacs gathering pus and increasing pain, medication and care may prevent premature death. If diet is irregular and Wind-Cold is not avoided, pathogenic qi forces invasion, sacs break and ulcerate, abdomen swells, Yin and Yang separate, and death comes within a day. If arising on the head/face, fear "Lou Jing Yong Quan" (Lou Jing: cheek perforation; Yong Quan: eye margin perforation). If on back/abdomen, fear "Feng Zhi Chen Shi" (Feng Zhi: whole-body stabbing pain; Chen Shi: widespread flesh rot). If on hands/feet, suffer indescribable misery ("Qing Bi"). If on Yang Qiu (testicles), fear testicular detachment. Yu Han says: "When天花 (smallpox) bears fruit, celebrate its completion; Wu Dou returns to the gate, smallpox inverted. If not turbulent waves in the canal, then joints will knot with carbuncles." Parents should be cautious.