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One: Diarrhea that does not stop after the scabs fall off, with spiritless eyes and a bluish complexion, indicates a fatal prognosis.
Two: Sudden onset of severe panting accompanied by lips and perioral area as white as withered wood indicates a fatal prognosis.
Three: Scars that are snow-white indicate exhaustion of Qi and Blood. Without vigorous tonification of Qi and Blood, death is inevitable.
Four: Convulsions occurring after the scabs fall off indicate exhaustion of Heart Qi, where the Spirit has no foundation and dissipates.
Five: Any case where swallowing food causes choking, a sawing sound in the throat, abdominal distension with empty rumbling, phlegm-panting, and sweating on the head indicates a fatal prognosis.
Six: Any case where one disease has not yet resolved before another arises, with the Five Elements engaging in mutual overcoming and multiplication, indicates a fatal prognosis.

When sores and scabs naturally detach and the acne scars are bright, neither protruding nor depressed, with skin and flesh smooth, and the appearance unchanged from before illness, adversity turns to prosperity, bringing a new beginning.
If after shedding scabs the scars are red or black, careful nurturing can allow them to fade; if they protrude, it should be discussed in terms of Wind-Heat; if they sink inward, it is known to result from interior deficiency.
After the pockmarks heal, scabs should naturally detach; if they remain for a long time, it indicates weak Spleen and Stomach. Do not let hair pull and damage the skin, turning over into sores with skin resembling peeled layers.
If there are many dark scars after scab detachment, do not assume there is no danger; who knows if toxic pathogens have returned to the Kidney? As long as the person's exterior and interior are harmonious, it is acceptable.
Delayed shedding of scabs during the healing phase, with drowsiness and preference for sleep, has no other cause; it is merely due to weak Qi and tired Spirit. Treat slowly to seek recovery; there is no need to sigh.
During the scabbing stage, Stomach Qi has not fully relaxed; how can diet provide surplus energy? If appetite increases, do not rejoice, as this indicates the pathogenic heat within has not been eliminated.
After sores, the body is newly deficient and Qi mechanism is unbalanced; further regulation is needed to ensure peace. Delicate skin is easily attacked by Wind-Cold; damaged intestines and stomach lead to stagnation of grains.
After scabs fall, the body is cool, and Blood and Qi are harmonious, indicating no pathogens in the exterior or interior. However, if the pulse is surging and the body is hot, guard against residual toxins; resolving toxins and regulating Ying (Nutritive) Qi brings great benefit.

Regarding dense pocks with clear pus water, if carbuncles or swellings appear after scabbing, people naturally know this is residual toxin. However, one must not ignore that high-pitched breathing with audible panting, chest heaving, and belly lifting indicates residual toxin in the Lung. Thick and sticky phlegm-saliva, teeth grinding, diarrhea, and foul breath indicate residual toxin in the Spleen and Stomach. Night sweats with fever, vexation, thirst, and frequent startles during sleep indicate residual toxin in the Heart. Eye pain and irritability indicate residual toxin in the Liver. Heat remaining in the ear helix indicates residual toxin in the Kidney. Body swelling that does not subside, persistent high fever, and depression indicate residual toxin in all meridians.
The *Dou Ke* (Pockmark Science) states: Residual toxins after smallpox manifest as three types: scabies, carbuncles, and red eyes. Scabies corresponds to Heart pathology. Carbuncles correspond to Spleen pathology. Red eyes correspond to Liver pathology. However, the eruption of fetal toxins varies among the five Zang organs. The Heart manifests as macules, the Spleen as papules, the Lung as pustules, the Liver as vesicles, and the Kidney as black inversions. Even at the initial stage of fever, each Zang organ presents symptoms. For example, yawning and palpitations belong to the Heart; neck stiffness and sudden oppression belong to the Liver; sneezing and coughing belong to the Lung; vomiting, diarrhea, and lethargy belong to the Spleen; cold ears and feet belong to the Kidney. How can one claim residual toxins only involve three organs? Moreover, the symptoms of these three organs are not limited to these. Perhaps the severe cases are cited to encourage deduction of others. If toxins return to the Heart, they manifest as macules/papules, convulsions, high fever, erysipelas, and various blood disorders. If toxins return to the Liver, they manifest as confusion, testicular swelling, dry retching, various eye diseases, and limb spasms. If toxins return to the Lung, they manifest as cough, panting, epistaxis, shoulder/arm pain, or dry, wrinkled, peeling sores. If toxins return to the Spleen, they manifest as foul mouth, vomiting/diarrhea, swelling, abdominal pain, anorexia, and limb diseases. If toxins return to the Kidney, they manifest as black inversion, excessive sleep, lower back pain, sudden loss of voice, and eventually fatal bone diseases from decayed sores. If toxins return to the Intestines and Stomach, they manifest as diarrhea, bloody/purulent stools, borborygmus, and constipation. If toxins return to the Bladder, they manifest as lower abdominal fullness/pain, hematuria, enuresis, head swelling/pain, and upward-gazing eyes. Only when Zang-Fu Qi and Blood are not severely deficient can residual toxins fail to lodge internally. If physicians fail to clear and resolve, toxic vapors linger in the collaterals, unable to vent externally through the skin or enter internally into the Zang-Fu, gathering and persisting to form carbuncles. Severe cases involve swelling and pain in the head, neck, brain, temples, hands, feet, and joints. Those with shallow roots are easy to treat. If roots are deep and spreading, affecting more than one or two areas, they destroy tendons and bones, causing disability, or lead to death after prolonged duration. Regarding red eyes, since Liver Blood is deficient, Fire attacks the empty orifices. Regarding scabies/leprosy-like conditions, they result from Blood deficiency with latent heat, representing the mildest form of toxin.
Smooth smallpox has a sparse base and mild toxin, naturally emerging and healing easily without residual toxins. Dangerous cases have a dense base and strong toxin, naturally difficult to emerge; even if healed, residual toxins may arise. Adverse cases involve inversions or inverted healing. Fortunately, relying on strong Spleen and Stomach constitution and early treatment, although symptoms recover, residual toxins may remain and erupt as disease, often involving scabies, carbuncles, red eyes, or smallpox toxins, which can be eliminated thereby. Thus, if after scab shedding there is no thirst, normal body temperature, regular bowel movements, no abdominal pain, strengthening spirit, increasing appetite, and red/rosy scars, there is no residual toxin. If there is fever with thirst, delirium, convulsions, floating and surging pulses throughout six positions, abdominal pain, vomiting/diarrhea, or red/astringent urine, hard/sticky stool, mental confusion, red/purple scars, limb fatigue, and reduced appetite, this indicates hidden residual toxins. One must examine the exterior/interior, excess/deficiency, Yang deficiency/Yin deficiency, and treat accordingly. However, after smallpox, both interior and exterior are deficient. It is crucial to avoid cold and heat, refrain from bathing too early to nourish the exterior; regulate diet and avoid sexual activity to nourish the interior. If exterior and interior are disharmonious, and Ying and Wei Qi rebel, carbuncles and pocks can form; why wait to ask about specific toxins! Toxins are caused by Yin-Yang imbalance and mutual overcoming; do they truly refer to有形 (formidable) malice? Furthermore, one must not indiscriminately use warming tonics due to deficiency. After healing, clearing residual toxins is appropriate, but cooling agents should not be used excessively, as Qi and Blood are greatly deficient. Treatment of smallpox carbuncles first requires assessing Qi to determine excess/deficiency, observing location and adding guiding herbs: add Angelicae Dahuricae Radix (Baizhi), Cimicifugae Rhizoma (Shengma), Ligusticum Chuanxiong Rhizoma (Chuanxiong) for the head; double the dose of Platycodonis Radix (Jiegeng) for the upper body; add Menthae Haplocalycis Herba (Bohe) for hands; add Cinnamomi Ramulus (Guizhi) for waist; add Achyranthis Bidentatae Radix (Niuxi) and Papaveris Semen (Muguwa - *Note: likely refers to Paeoniae Radix Alba or similar for legs/knees, text says Mugua*) for legs and knees. This is a general outline. If Qi is substantial and appetite good, with hard stool, use Paidu San (Detoxification Powder) to promote drainage. If intake is small and Qi deficient, use Shixuan San (Ten Acupoints Decoction) type formulas to support the interior. For shallow and minor toxins, use Xiaochaihu Tang (Minor Bupleurum Decoction) with modifications externally applied with Badu Gao (Toxin-Drawing Plaster); this is the method for treating abscesses. If swelling has formed, assess toxin severity or Qi/Blood deficiency, and resolve toxins while supporting with tonification. If ulcerated with pus but not broken, puncture with a needle to drain pus, preventing internal rupture. If already broken, primarily use Shiquan Dabu Tang (Complete Great Tonifying Decoction), slightly resolving residual toxins; this is the method for treating ulcers. However, Qi and Blood easily stagnate in flexural areas, so smallpox toxins often occur at elbows, wrists, knees, and ankles. Those at wrists belong to Taiyin Lung; those at ankles belong to Taiyin Spleen; both should be treated with Jiedu Neituo San (Resolving-Toxin Interior-Supporting Powder). Since carbuncles arise from smallpox, and smallpox is Yang toxin, it is called "Smallpox Carbuncle"; mostly solid toxins and Blood-heat, so clearing heat and cooling Blood is primary. However, in cases of Qi/Blood deficiency-cold and weak Yuan Shen, using cooling-blood detoxifying methods will inevitably cause formed lesions to fail to suppurate and suppurated lesions to fail to heal. Therefore, appropriateness is valued, and prescriptions are not rigid.
Smallpox toxin accumulating in skin and muscles with unresolved stagnant heat prevents Ying and Wei from circulating, forming boils and furuncles. Severe cases become red and swollen, forming carbuncle toxins. Before suppuration, urgently release the exterior and detoxify to facilitate dispersion. Once pus forms, cool Blood, invigorate Blood, resolve toxins, and support the interior to facilitate healing. If pus is ripe, it must be drained by needle puncture; external plasters must be applied. Without puncturing, tendons and bones are harmed; without plasters, toxins attack internally. Generally, when swelling/toxins first appear, if blood color is active and painful, easily forming, suppurating, and healing, it indicates Yuan Qi presence and superficial redness, an auspicious sign. The opposite is inauspicious. Eruptions within twelve days mostly occur on legs and feet because smallpox toxin Qi transmits downward. Eruptions at Yongquan (KI1) or Chongyang (ST42) are ominous. Eruptions at Taixi (KI3) on the medial malleolus are fatal, as toxins erupt from the Kidney. Eruptions after sixteen days indicate ascending Qi, with toxins reaching upward, thus mostly appearing on the upper body and head, usually harmless. After smallpox, if widespread skin sores/scabies like eruptions with purulent discharge, skin ulceration, and non-healing for a long time, toxic vapors permeate the skin; use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) type formulas. If caused by scratching into sores, apply Baihua Gao (Hundred Flowers Ointment). If red spots appear without swelling or pain, these are macules; administer Huaban Tang (Macule-Resolving Decoction) with added Scrophulariae Radix (Xuanshen) and Rehmanniae Radix (Dihuang). If red fire erysipelas tumors erupt, this is a malignant condition. Toxins cause red swelling and pain, intolerable to touch, migrating up and down. Internally use Xiaochaihu Tang plus Sheng Dihuang (Raw Rehmannia) to stimulate, and Xuanshen Huadu Tang (Scrophularia Toxin-Resolving Decoction). Externally use Bianfa (Stone Needle Therapy) to remove bad blood. Otherwise, if arising on the head, crossing the Heart leads to death; if arising on feet, crossing Heart and Kidney leads to death.