痘至十日。毒解矣。脓亦转黄作苍蜡色。元气实者。痂必循次而结。如口角与阳物先结
。正收也。身渐轻快。肿渐清解眼蒙蒙而欲开。食倍常。便如故。从上至下而收。结痂浓色
红。大事毕矣。不然犹未可以为喜。结痂时。忽忽发热者。蒸浆作靥也。不必虑。
凡一时痂尽。一痂即落者。毒火烁也。急解之。此症必脓未充足。若声哑烦闷。喘促不
食。死期迫矣。否则必发痈毒而解。
痘至十日。正收靥之期。靥而不靥。非气虚。必血热也。气虚方内加参 。丁柱治之。
血热方内加
芩连。解毒治之气虚血热唇舌红不红辨之也。亦有时令致然者。时之寒也。用温剂以敛之。
时之热也。用凉剂以清之。
凡不及期眼开者重。轻症不拘。又过期眼不开者亦重。十二日眼开期矣。
当结靥时。渴饮无休。津液竭矣。方内加生脉散主之。若渴甚而下泻。尤重者。为难治
。凡治渴。切勿利小便。便愈利而渴愈甚矣。
十日九日。半痂半不痂。作泻者。不必虑。乃阳气内回。非贯脓时比也。方内倍白术
。茯苓治之。切忌涩剂。倘不知误用。后必不食而作痢。
十二十三日。有形如火烧烟熏者。生死最决。若音不清。食不入。破处干枯。烦乱不寐
。死症也。音清能食。睡卧安宁。爬破淋漓。神舒气爽。生症也。又当分虚实治。唇舌洁净。温
补兼清解之。唇燥舌苔。单解之。解而苔去。继以平和则攻补两尽矣。
凡当靥时而流浆不已。为过表故也。然亦有饮水霪湿。致然者。两者皆方内倍白术。茯
苓。
。空处复出一层。治功也。俗呼曰翻空痘逆症有此。大吉也。靥后腮红。唇干。面色带紫者
。肺痈将作也。连翘饮治之。桔梗。知母。百合。麦冬宜常服。
痘至结靥未及结痂时必定作气息者第腥臭者佳尸臭者死。全无气息知有余毒也。须解之
额与足迟靥者。独阴独阳也。额与足先靥者重反阴背阳也。当靥之时。凡见腹胀。气喘
。咽
皆死症也。间有一二不死。亦幸活耳。
When the smallpox reaches the tenth day, the pathogenic toxin is resolved. The pus turns yellow and assumes a pale wax color. In patients with substantial Yuan Qi (Primordial Qi), the scabs will form sequentially; for instance, if the corners of the mouth and the genitalia form scabs first, this indicates normal contraction. The body gradually feels light and brisk, swelling subsides, eyes become hazy yet desire to open, appetite doubles as usual, and bowel movements return to normal. Contraction proceeds from top to bottom; when the scabs are thick and red, the major crisis is concluded. If this does not occur, there is no cause for joy yet. During the scabbing process, if sudden fever occurs, it is due to the steaming of pus to form scabs; there is no need to worry.
If all scabs form simultaneously and one falls off only for another to fall immediately, it indicates blazing toxin-fire, requiring urgent detoxification. This condition implies insufficient pus formation. If hoarseness, restlessness, panting, and anorexia appear, death is imminent. Otherwise, carbuncles and sores may erupt, leading to recovery.
The tenth day is the proper time for scabbing (jie ye). Failure to scab indicates either Qi deficiency or Blood heat. For Qi deficiency, add Ren Shen (Ginseng) to the formula; Dr. Ding Zhu treats this condition. For Blood heat, add Huang Qin (Scutellaria Root) and Lian Qiao (for detoxification, though text says Qin Lian, implying Scutellaria and Coptis) to the formula. Qi deficiency versus Blood heat can be distinguished by observing whether the lips and tongue are red. Sometimes, seasonal factors are responsible: if the climate is cold, use warm formulas to consolidate; if hot, use cool formulas to clear.
If the eyes open before the appropriate time, the condition is severe (light cases aside). Conversely, if the eyes do not open after the appropriate time, the condition is also severe. The twelfth day is the deadline for the eyes to open.
During scabbing, if thirst persists without cessation, it indicates exhaustion of Jin Ye (Body Fluids); add Sheng Mai San (Generating the Pulse Powder) to the formula. If severe thirst is accompanied by diarrhea, it is particularly severe and difficult to treat. When treating thirst, never use diuretics; the more you promote urination, the worse the thirst becomes.
On the ninth or tenth day, if half the lesions have scabbed and half have not, accompanied by diarrhea, there is no need to worry. This represents the return of Yang Qi internally, which differs from the pus-filling stage. Increase the dosage of Bai Zhu (Atractylodes Rhizome) and Fu Ling (Poria) in the formula. Strictly avoid astringent herbs; misuse may lead to anorexia and dysentery later.
From the tenth to thirteenth days, lesions resembling burns or smoke stains indicate a definitive prognosis regarding life or death. If the voice is unclear, food cannot be taken, broken areas are dry, and there is restlessness with insomnia, it is a fatal sign. If the voice is clear, food is tolerated, sleep is peaceful, and scratching leads to oozing pus while the spirit is calm and breath is fresh, it is a vital sign. Treatment must distinguish between deficiency and excess: if lips and tongue are clean, use warming tonification combined with clearing and resolving; if lips are dry and tongue has coating, use clearing methods alone. After the coating clears, follow with mild formulas to achieve both expulsion of pathogens and tonification.
If pus flows incessantly during scabbing, it is due to excessive sweating (releasing the exterior). However, it may also result from excessive water intake causing dampness stagnation. In both cases, increase Bai Zhu and Fu Ling in the formula. If new pustules emerge in empty spaces, it is a sign of therapeutic efficacy. Commonly called "Fan Kong Dou" (Reversing Empty Pox), its appearance in adverse conditions is a great auspicious sign. After scabbing, if cheeks are red, lips are dry, and complexion is purplish, Lung Abscess (Fei Yong) is about to develop; treat with Liao Qiao Yin (Forsythia Decoction). Jie Geng (Platycodon Root), Zhi Mu (Anemarrhena Rhizome), Bai He (Lily Bulb), and Mai Dong (Ophiopogon Tuber) should be taken regularly.
At the scabbing stage, before scabs fully form, there is invariably an odor. A fishy smell is auspicious; a corpse-like smell indicates death. No odor at all indicates residual toxins that must be cleared. Delayed scabbing on the forehead and feet indicates separation of Yin and Yang (Du Yin Du Yang). Early scabbing on the forehead and feet indicates severity, representing inverted Yin and Yang. During scabbing, any presentation of abdominal distension, panting, or throat obstruction constitutes a fatal sign. Occasionally, one or two may survive, but only by extreme luck.