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When the smallpox pustules are mature, their appearance resembles that of a ripe fruit. There is no abnormal discoloration externally, and internally there is abundant fluid. The pus is full and white-grayish in color; under these conditions, one may expect scabbing to form on schedule.

When reaching the stage of pus formation, it is crucial to ensure sufficient pus. One must strictly guard against clear watery discharge and empty blisters. Empty blisters without fluid indicate that pathogenic factors remain latent. Clear fluid is not true pus, and the accompanying itching is unbearable.

The formation of pus originates from Qi and Blood, while the transformation of toxins into pus relies on the efficacy of Qi and Blood. If one does not understand how to tonify Qi and Blood to fill the pustules, it is like attempting to steam rice without rice or flour.

People often say to wait for pus formation, but they do not realize that pus formation alone is not entirely reliable. Although fullness and firmness are indeed gratifying, excessive dampness leading to soft and thin pustules is alarming.

Loss of gas (flatulence) is originally related to the Foot-Taiyin Spleen Meridian, while rumbling in the intestines relates to the Foot-Yangming Stomach Meridian. Even ordinary diarrhea should not be taken lightly, as the depletion of Grain Qi signals the approach of death.

For the whole-body sores to form pus, the key lies in the strength of the patient's Spleen and Stomach. If food intake is reduced but stool is hard, it indicates sufficient Middle Qi. If stool is loose but appetite remains, there is no cause for concern.

The skin of the smallpox sores is tender with a bright red color. As pus forms, itching intensifies. At this stage, preemptive tonification and support (Bu Tuo) therapy is essential. Upon rupture, the presence of substantial pus is critical for support.

The normal color of smallpox sores prefers bright red. However, at the pus stage, this changes: whitish or grayish colors are considered normal. If the color remains tender red, it is pathological.

Sores on the front of the face must not be injured. Injury to even one spot is an inauspicious sign. If itching becomes uncontrollable, leading to rupture, depression, dryness, or flattening, death will occur shortly.

Sores on the forehead resemble boiling water being poured over them. After bathing, the facial skin becomes broken and unstable. If this spreads to the cheeks, it indicates the exhaustion of Primordial Yang and the persistence of toxins.

Sores on the nose tip, above the lips, between the eyebrows, and around the ears must not be neglected. If they turn dark before pus forms, do not mistake this dry scabbing for normal healing, which would delay treatment.

Pustules on the hands and feet require full pus. Full, plump, and grayish-white characteristics indicate strong Spleen Qi. Pale, thin, grayish-white lesions resembling packed grain suggest that even if dry scabs form, adverse consequences will follow.

Nine to ten days after eruption, dry red scabs have formed. If there is any irregularity, pus pits may form at this stage. Since the stage of full pus has been reached, recovery must proceed sequentially. If severe fever occurs, preventing scabbing, this indicates Hyperactive Yang and Yin Deficiency, requiring cooling and astringent therapies. Full pus with shortness of breath suggests phlegm obstruction; sudden convulsions may indicate constipation. Further signs of Qi deficiency with depression, inverted scabbing, and blackened/scorched appearance can be treated with warming tonification or attacking methods to save the patient. If diarrhea is calm, it indicates severe deficiency with little toxin. Cold in the Lungs leads to purulent diarrhea; Zang-Toxin causes bloody stools. Throat trauma with hoarseness is acceptable if pus is full. Depression with teeth grinding is treatable if stool is solid and voice is clear. Hard scabs prevent complications; desquamation like bran requires vigilance against residual toxins. Excessive cases lead to difficult-to-treat ulceration. Fever must be managed. "Liao-pao" (burning blisters) are feared; empty shells failing to scab result from excessive heat clearing in the pus. Abdominal distension, wheezing, and collapsed scabs indicate internal toxin attack. Failure to produce yellow pus results in blood-red scabs. Prior detoxification yields excellent prognosis. Swollen/hard lips indicate failure of Stomach Qi. White eye discharge indicates excessive Liver Heat. Wheezing after diarrhea indicates Qi deficiency; diarrhea followed by thirst/irritability is not excess heat. Persistent diarrhea with thirst requires lifting strategies. Drinking increases thirst, indicating poor prognosis. Qi deficiency with chills requires warming meridians if sores are safe; full pus with difficulty recovering and solid stool with steaming heat requires resolving/diuresis. Cooling aids scabbing; tonification must be guarded against excess. After scab falling, gradually cool; once toxins are gone, gently tonify. Shengma (Cimicifugae Rhizoma) harmonizes early. Detoxifying formulas are used near scabbing.

Although scabbing indicates eight or nine parts of life remaining, residual toxins may change. Closed eyes and abdominal distension still pose crises. Persistent floating edema is ominous. Loss of voice despite scabbing suggests black scabs. Eyes opening before swelling subsides suggests internal attack. Extreme Yang leads to screaming and wheezing. Intestinal injury causes unrest. Wind-cold entering the Stomach causes purulent diarrhea; Heat seeping into the Bladder causes hematuria. Lingering heat/toxins causing high fever/chills after scabbing indicate residual toxins in meridians. Evening tidal fever occurs. Morning onset with irritability/thirst/red cheeks indicates Excess. Afternoon onset with loose stool/reduced appetite indicates Yin Deficiency. Lip curling/tongue playing indicates Heart Heat. Holding belly/chest indicates Lung/Stomach toxin. High fever, constipation, and risk of acute convulsions. Chronic low-grade fever with loose stool may become Slow-Spleen Wind. Blindness/light sensitivity indicates Eye issues; mouth ulcers/black gums indicate Lip/Gum issues. Excess heat sinking to Large Intestine causes constipation; Deficient-Cold in Zang organs causes diarrhea. Thirst/wheezing must distinguish Excess/Deficiency. Scab color analysis follows: Peach-red/glossy indicates healthy Ying-Wei; Black-purple/dry indicates lingering Wind-Heat. Powder-white indicates Qi/Blood deficiency; deep scars imply severe past illness. Rapidly progressing gangrenous stomatitis or widespread red spots indicate failure to resolve/diurese. Whole-body cyanosis suggests Wind-Cold invasion. Residual toxins may cause carbuncles/furuncles. Early wind exposure risks recurrence.

After smallpox matures into pus, appearing bright, plump, firm, and slightly scorched/hard upon touch, scabbing is imminent. Sequential scabbing (front/back, large/small) is ideal—not too fast, not too slow. Normal scabs are round, smooth, clean, yellow-moist, without excessive wetness or rupture. This indicates external release of congenital toxin and return of congenital Yuan Qi to the center, symbolizing extreme turning to prosperity. Folk sayings about days for fever, eruption, rising, pus, and scabbing are generalizations. Pustule density, toxin depth, and person's deficiency/excess vary. Sparse sores/mild toxin/strong constitution/eating well = easy eruption/scabbing. Dense sores/heavy toxin/eating well/Middle Qi strong/Qi-Blood harmonious/no violations = predictable timeline. Weak Middle Qi/poor diet/internal injury/external pathogen/climate deviation = difficult scabbing, cannot compare to others.

During scabbing, toxins are resolved, but order and pace matter. Too fast: scanty pus/blood, unexhausted toxins, boiling fluids, rapid drying, residual toxins, or death. Mild purgation clears toxins. Too slow: weak Middle Qi/Spleen-Stomach, inability to absorb dampness. Use Ginseng/Atractylodes/Kudzu root (Shen, Bai Zhu, Ge Gen) to tonify Spleen; use Baicao San (Grass-Destroying Powder) to observe.

Scabbing after pus is normal. Sores failing to scab after time limit with body-wide ulceration differ from macular eruptions. Six causes exist:
1. Constipation, extreme internal/external heat, exterior-interior excess, steaming heat, scattered toxins, strong Yang lacking Yin to restrain → Cool or purge.
2. Diarrhea, interior deficiency, weak Spleen-Stomach, damaged fluids, empty muscles, scattered Yuan Qi, insecure exterior-interior, strong Yin lacking Yang to restrain → Warm tonification.
3. Excessive cold water drinking, water flooding Spleen, dampness invading muscles → Leach dampness.
4. Cold weather, lack of covering, frostbite, coagulated blood/stagnant toxins → Warm harmony.
5. Hot weather, seeking warmth, heat steaming sores → Cooling.
6. Poor diet, Qi deficiency → Tonify Spleen.
Treating un-ulcerated sores leads to scabbing; treating ulcerated ones leads to gradual scabbing—good omens. Failure to scab leads to inverted scabbing and danger. Smallpox completion resembles autumn harvest: grains need Yang Qi to mature; without cool wind, they don't fill. Heaven-Earth solemn Qi makes things flourish and fill. Without Yang harmony, shoots don't flourish; without solemnity, flourishing doesn't fill. Pus without scabbing is like shoots without filling. Treaters may use cooling resolution or purging to enforce solemnity. However, post-pus Qi-Blood depletion causes non-scabbing. Symptoms mimic excess heat but are false heat from severe deficiency. Do not treat as previous cases; use Shiquan Dabu Decoction (Ten Significant Tonifying Decoction). Later fatigue/chills indicate pathogen retreat and Zheng Qi recovery, showing deficiency. This matches the Classic: "When Zheng Qi is depleted, deficiency appears." Continue previous medicine for self-healing. Ulcerated weeping pus sticking to mats causes pain; use Baicao San, place mat underneath, sprinkle silk bag contents on body. Facial scar prevention: use Jianban San (Scar-Reducing Powder) mixed with Baihua Gao (Hundred Flowers Ointment).

Ren and Du meridians intersect at Renzhong (GV26). Du is Yang, ascending from Renzhong. Ren is Yin, descending from Renzhong. Tai Hexagram represents this: upper three lines above Renzhong (Yang), lower three below (Yin). Hairline above is Upper Yang; between eyebrows is Middle Yang; below Shan Gen (bridge of nose) is Lower Yang. Mouth to breasts is Upper Yin; Xian Gu (xiphoid) to genitals is Middle Yin; below genitals is Lower Yin. Nose tip to Yintang corresponds to chin to Ji Wei (CV10); Yintang to hairline corresponds to Ji Wei to knees; above hairline corresponds to below knees. Observing facial scabbing reveals body scabbing progress. Deviation is abnormal. Auspicious: Renzhong area, lip sides erupting/scabbing first (Yin-Yang harmony). Head-to-foot progression is Smooth; foot-to-head is Reverse. Forehead-first scabbing is "Solitary Yang not growing"; foot-first is "Solitary Yin not lengthening"—both ominous. Creation logic: Yang born, Yin completes; Yin master, Yang completes. Head above hairline is Solitary Yang; feet below knees is Solitary Yin. These two areas are naturally hardest to scab after other sores heal; do not diagnose as inverted scabbing.