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When the smallpox lesions reach the stage of scabbing and falling off, it seems that the great work is accomplished and everything is settled. But should I say more? The response is: What kind of talk is this? The final stage is difficult to rely on; "a job undone by a single basket of earth" (falling short at the last moment) precisely describes this situation.

If the scabs do not fall off for a long time, or pile up like chicken droppings, or are as thin as bamboo membrane; if blisters and red rashes tangle together, carbuncles and sores ulcerate, or rashes appear, or measles erupt, or vomiting and thirst occur, or dysentery with red and white discharge appears, or coughing occurs, or deficiency heat causes irritability and insomnia, sitting or standing with slight trembling, lips unable to cover the teeth, hoarse throat with abdominal pain, fever, or itching, and the color is pinkish-red—is this not a dangerous condition?

Furthermore, if the lesions break but fail to penetrate fully, becoming sunken, dry, and withered; if there are convulsions and loss of spirit; if gangrenous stomatitis (Zouma Yagan, 走马牙疳) occurs, eyes become dim or deviate upward (Diao Bai, 吊白); if the chest is elevated with panting, and tremors ceaseless; if the scar colors are all pinkish without redness—is this not an adverse condition? Moreover, when Qi and Blood have just stabilized, Ministerial Fire (Xiang Huo, 相火) is prone to flare up. Even if the scars turn red after healing, failing to avoid pungent and hot foods will still cause eye diseases; failing to shield against wind and cold will still trigger sores; failing to regulate diet will still lead to vomiting, dysentery, and other syndromes. How can you treat this as if nothing were wrong?

As scabs gradually form and fall off, bright and dense colors indicate a favorable course (Shun, 顺). Some may stick to the flesh without falling off, some may be embedded in the flesh, some half-stuck and half-peeled, some scabs partially covered with exudate, some thin as bamboo membrane, or black as coal—these are dangerous signs. There are distinctions between deficiency/excess and cold/heat. For excess-heat patterns, Lianqiao Yin (Forsythia Decoction) is the primary treatment. For deficiency-cold patterns, Ginseng (Renshen, 人参) and Cinnamon Twig (Rougui, 肉桂) are added to the formula. The same applies to treating the color of the healed lesions. Purple-red indicates excess; pinkish-red indicates deficiency; pinkish-white indicates decline of Qi and Blood. If Qi and Blood are declining and medication fails to improve the condition, death ensues.

The excess toxins within the smallpox cannot remain in the body, so they seek orifices to exit. The Classics state: "When Ying Qi (Nutritive Qi) does not flow smoothly and rebels within the muscle tissue, swelling arises." The area where Quchi (LI11), Weizhong (BL40), and Sanyinjiao (SP6) converge is where toxins often stagnate due to deficiency. However, there are also excess and deficiency cases. Those with weak constitutions, poor appetite, slight fever, and non-painful swelling are deficient. Those with robust constitutions, body heat, good appetite, and incessant painful crying are excessive. Deficient patterns are treated with Liqi Yin (Flowing Qi Decoction); excessive patterns with Lianqiao Yin. Externally, Bisheng Gao (Victory Ointment) is applied to promote suppuration. For wounds that do not close for a long time, Dabu Tang (Great Tonification Decoction) is used; for those that do not heal, Shengji Gao (Tissue Regeneration Ointment) is applied. If many patients with carbuncles refuse food, suffer from continuous vomiting and diarrhea, have ptotic eyelids and pale lips, and secrete clear water-like pus, they will die.

Eye diseases after smallpox are commonly believed by laypeople to be caused by pox appearing in the eyes, compounded by other factors. Why is it not seen that pox suppurates and then forms scabs? This syndrome is also the fault of the physician. Ancient wisdom states: "Heat accumulating in the Liver leads to eye disease," which is accurate. If there is redness, swelling, and pain preventing the eyes from opening, Chizhong Lianggan San (Redness-Swelling Cooling Liver Powder) is used; if nebulae (Yi Mo, 翳膜) are present, Liangge San (Cooling Partition Powder) is used. Eye drops must be strictly avoided; if the eyeball protrudes and the pupil sinks, it is incurable. If eye protection methods were employed when the smallpox first erupted, there would be no subsequent complications.

Dan Kou Gan (Gangrenous Stomatitis of the Mouth) is caused by Stomach Heat. It varies from mild to severe, with some cases being fatal. White plaques covering the entire mouth, or clusters of red spots, indicate mild cases. Lingzao Dan (Spirit Date Pill) is insufflated into the lesion. Swollen and stiff lips and tongue, with black and rotting gums forming gangrene, indicate severe cases. Internally, Ganlu Yin (Sweet Dew Decoction) is taken; externally, Lingzao Dan is insufflated. If the rot extends into the throat, medication is also insufflated. If the color resembles dried sauce, the foul odor and rot worsen daily, and red spots appear on the nose, death occurs. This is commonly known as Zouma Gan (Running Horse Gangrene). However, this is also the fault of the physician.

Severe abdominal pain after smallpox requires differentiated treatment. For food stagnation, Hezhong Wan (Harmonize Middle Pill) is used. For residual toxins, Lianqiao Yin is used. For blood deficiency, the base formula has Forsythia (Lianqiao) and Platycodon (Jiegeng) removed, and Ginseng (Renshen) and Dried Ginger (Ganjiang, 干姜) are added. Abdominal pain accompanied by a white tongue coating indicates death, signifying exhaustion of Yuan Qi (Original Qi).

Convulsions after smallpox: texts state that cases are incurable if the eyes are closed and spiritless, combined with vomiting, diarrhea, pale lips, and cold limbs. If high fever causes urinary obstruction, or if there is a pre-existing history of convulsive disorders, these are not necessarily untreatable. Hoarseness after smallpox is named Sha (Sand/Rash). This is actually an auspicious sign following the shedding of scabs and should not be treated as ordinary Sha or measles; only dispersing-wind formulas are needed. Dan (Erysipelas) and Urticaria (Yin Zhen, 瘾疹) are treated similarly.

Edema after smallpox, with the scrotum enlarged like a bowl, indicates toxins hidden in the skin. Lianqiao Yin is used with Betel Nut Peel (Fupi, 腹皮) and Yinchen (Artemisia Capillaris) as the main treatment. In some cases, Aurantium (Zhike, 枳壳) is added, and Bupleurum (Chaihu, 柴胡) is doubled.