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When the smallpox pustules should be scabbing over, if no dense pus is seen all over the body, but only those around the mouth and lips turn yellow and mature first, this indicates that the toxic qi has attacked the Spleen internally. Furthermore, cases where all pustules have not yet scabbed over while the lips are rotting first, or where the lips are white extending to the tongue, are all considered incurable.

If at the stage of scabbing over, the patient chews emptily without anything in the mouth, death ensues.

If the pustules on the face and abdomen have not yet scabbed over, but those on the feet scab first, it is incurable. This is because Yin prevails over Yang.

If the pustules all over the body are foul and putrid to the point of being unbearable, accompanied by phlegm obstruction, shortness of breath, closed eyes, and lack of spirit, death ensues.

If the pustules itch, are scratched open, reveal no pus or blood, and the skin becomes flaccid and dry like shriveled beans or grains, it is incurable.

Just before scabbing over, if there are rigors, teeth grinding, trembling of hands and feet, locked jaw with closed eyes, abdominal distension, and coldness of the feet extending above the knees, it is incurable.

If most pustules fail to scab over, leaving a few remaining unscabbed, this is akin to a snake shedding its skin where one segment is damaged and does not shed completely; ultimately, death will occur. Therefore, caution is essential.

If the pustules reach below the neck or to the chest and remain stationary without scabbing, and medication proves ineffective, since the chest is the residence of Qi, this indicates that both Qi and Blood are exhausted, making it incurable.

If the pustule skin is thin and soft, white as plum blossom petals, scabs thinly and falls off easily, leaving white scars with dried blood, this is called "false scabbing" (Jia Ye). Within eleven or twelve days, toxic qi will attack internally leading to death; urgent administration of decoctions to warm and tonify Qi and Blood is required.

However, if accompanied by diarrhea, wheezing and thirst, abdominal distension, and rigors with teeth grinding, it is incurable.

If both cheeks are dry and hard, feeling like stone upon pressure, along with incessant diarrhea, generalized maceration and rotting, hoarseness, and cold feet, death ensues.

If there is choking sound when drinking water, or incessant dry retching, failure of scabs to detach, loss of appetite, and mental confusion or restlessness, death ensues.

If the gums rot and emit an odor too foul to bear, this is termed "rotten Stomach," which is incurable.

Any case showing tongue protrusion and playfulness after illness is ominous.

If after smallpox, wind-cold or food stagnation leads to immediate emaciation and debility, it is incurable. This is because the Spleen governs muscles, indicating a collapse of Earth and failure of the Spleen.

The boundary between Yin and Yang lies at the Renzhong (GV26) acupoint, with the Ren and Du meridians connecting from above and below. It is appropriate for scabbing to gradually occur here, allowing Yin and Yang to assist each other to achieve harmony.

Yin and Yang assisting each other leads to mutual completion; if Yin is deficient and Yang isolated, the vital force cannot circulate. If you do not believe this, observe the head and feet; the principle of difficult scabbing in smallpox becomes clear.

Do not say that no pathogenic factors remain during the scabbing phase; neither too fast nor too slow is ideal. Too rapid risks accumulation of residual toxins; too slow leads to ulceration preventing scab formation.

One must know the different types of foul odors from sores; laypeople often confuse them. Seeing this during suppuration is an evil omen, whereas seeing it during scabbing should be regarded as auspicious.

When the pus dries up all over the body, people often neglect this stage and relax their vigilance. Not knowing that taboos frequently change, one may fail at the last step, just as a nine-ren-high mountain fails due to a basket of earth left unfinished.

Do not rigidly adhere to specific days for scabbing; standards vary. Instead, assess the density of the original pustules and discuss the deficiency or excess constitution of the patient.

At the time of scabbing, pus naturally dries; retention and gathering should be complete and round. Do not allow ulceration or damage to tender scabs; at this stage, also check for inverted scabbing (Dao Ye).

Scabbing is originally prized for its neatness; foul smell and ulceration indicate a perilous time. If these signs appear after the expected period, it may still be considered a favorable progression; if they appear prematurely, they are deduced as adverse reversals.