十朝浆足应收靥，先蜡后粟似螺形，不疾不徐循次结，痂润身和顺证明。
[注]
十朝浆足者，谓应收靥结痂之期，
然必先如蜡黄，后如粟壳之色，痂似旋螺高起，则为上吉之痘，
不疾不徐者，谓先苍老者先收靥结痂，次苍老者次收靥结痂，
从上而下，循次而结，且更痂润有光，身和无病，为顺证无疑矣。
%
险证装足色不苍，停浆不靥或烂伤，痂色紫黑不即脱，便调食美不须慌。
[注]
收靥险证，谓浆虽足而色不苍也，
停浆不靥，谓过期浆不靥结也，
烂者，谓痘颗溃烂也，
伤者，谓痒抓伤损也，
痂色紫黑者，谓痘痂色紫黑也，
不即脱者，谓痘虽结痂不即脱落也，
以上诸证，皆收靥险证，
若二便调和，饮食强美，则化险为顺不须惊慌也。
%
不靥外剥为逆证，麸薄黑黯淡白凶，痂靥粘连终不脱，虽脱干枯亦死形。
[注]
不靥外剥者，谓痘不待收靥而皮若剥去，此名倒靥，则为逆证，
麸薄黯黑者，谓痘痂形色若麸之薄，若煤之黑，
淡白者，谓痂色淡白无光，故皆为凶也，
粘连不脱者，谓脓汁粘连久不脱落也，
虽脱干枯者，谓痘痂虽脱而干枯不润也。
此二者亦为死形也。
%
浆足苍老顶微焦，渐次收靥不须疗，太迟太速皆非吉，须辨虚毒湿火条，
浆清皮嫩为虚象，焮赤溃臭毒热淆，浆水浸渍湿淫胜，靥速窠燥火煎熬。
[注]
浆至充足，其色苍老，痘顶微焦，循次收靥，皆收靥顺证，不须疗治也，
太迟者，谓当靥不靥也，
太速者，谓不当靥而靥也，皆非吉痘，
然当辨其所属，或不足或毒盛，或属湿饮或属火盛，须按证治之，
如浆清皮嫩，此属不足，虽敛也，焮赤溃臭，此属毒盛难敛也，
浆水浸渍，此属湿盛难敛也，
靥速窠燥，此属火盛敛早也，治者须详辨之。
%
回浆饮
皮嫩浆清收敛迟，此证当从不足医，回浆参芩白术草，首乌白芍炙黄耆。
[注]
痘至收敛之时，当靥不靥，皮嫩浆薄，现证身凉手足冷，二便不实者，
此原气不足虚证也，宜用回浆饮补之，助其收结。
(回浆饮) 人参 黄耆蜜炙 白茯苓 白术土炒 何首乌炙，白芍炒 甘草炙
引用煨姜水煎服。
%
大连翘饮
焮赤溃臭因毒盛，大连翘饮诸热清，柴芩归芍车栀草，翘蒡荆防蝉滑通。
[注]
痘当收敛之时，有因毒盛而难敛者，
更现证焮肿而赤，溃烂而臭，通身大热，烦渴不宁，此毒气大盛之故也，
须用大连翘饮以解之。
(大连翘饮)连翘去心 防风 牛蒡子炒研 荆芥 黄芩 当归 蝉蜕 柴胡
滑石 栀子 赤芍 车前子 木通 甘草生 引加灯心水煎服。
%
除湿汤
遍体浸渍出水浆，证属湿饮在脾乡，除湿赤苓猪通泽，薄桂苍防白术羌。
[注]
痘当收敛之时，有因湿盛而不得敛者，
其现证轻则有孔漏装，重则遍体溃烂，肚腹胀，小便短，皆湿饮为患也，
须用除湿汤以利之，湿除而痘自靥矣。
(除湿汤)
羌活 苍术米泔水浸炒 防风 赤芍 猪苓 泽泻 白术上炒 木通 薄桂
引加生姜灯心水煎服。
%
清毒散
靥速皆因是火伤，遍体窠燥异寻常，清毒归芍连丹草，翘蒡通花生地黄。
[注]
痘不当收敛之时，忽一时收敛者，
更现证过身窠粒干燥，口渴发热烦急不宁，此毒火壅盛之故也，
宜用清毒散主之。
(清毒散) 生地 赤芍 连翘去心 金银花 牛蒡子炒研 木通 黄连
当归 丹皮 甘草生水煎服。
%
On the tenth day, when the pustules are full of fluid, they should begin to dry and form scabs. Initially resembling the yellow of wax, then taking on the color of millet husks, with shapes resembling spiral shells, drying neither too fast nor too slow but in sequence, with moist scabs and a harmonious body condition, this indicates a favorable progression (Shun Zheng).
[Note]
"Full fluid on the tenth day" refers to the period when drying and scabbing should occur.
However, the color must first resemble wax yellow, then millet husk color, and the scabs should protrude like spiral shells; this is the most auspicious sign for smallpox.
"Not too fast, not too slow" means that those with darker, mature colors dry and scab first, followed by those with lighter colors.
Drying from top to bottom in sequence, with glossy, moist scabs and no signs of illness in the body, undoubtedly constitutes a favorable progression.
In dangerous progressions, although the pustules are full of fluid, the color is not dark/mature. Fluid stagnation without scabbing, or ulceration and injury, purple-black scabs that do not shed immediately: if bowel movements are regulated and appetite is good, there is no need to panic.
[Note]
Dangerous progression during scabbing refers to cases where fluid is sufficient but the color lacks maturity.
"Fluid stagnation without scabbing" refers to exceeding the time limit without scab formation.
"Ulceration" refers to the bursting and rotting of pustules.
"Injury" refers to damage caused by scratching due to itching.
"Purple-black scabs" refers to the dark purple-black color of the scabs.
"Not shedding immediately" refers to scabs forming but not detaching promptly.
All the above conditions constitute dangerous progressions during scabbing.
If urination and defecation are harmonious, and diet is robust and appetizing, the condition can transform from danger to safety without panic.
Failure to scab accompanied by external peeling is an adverse progression (Ni Zheng). Scabs thin as bran, dark and dull, or pale white are ominous signs. Scabs adhering without shedding until the end, or even if shed, remaining dry and withered, indicate a fatal outcome.
[Note]
"Failure to scab with external peeling" refers to skin peeling off before natural scabbing occurs, known as inverted scabbing (Dao Ye), which is an adverse progression.
"Thin as bran, dark as soot" refers to scabs being thin like wheat bran and black like coal.
"Pale white" refers to scabs lacking luster, thus all considered ominous.
"Adhering without shedding" refers to prolonged adhesion due to pus exudate.
"Dry and withered even after shedding" refers to scabs detaching but remaining dry and unmoistened.
These two scenarios also represent fatal forms.
When fluid is abundant, color is mature, and the pustule apex is slightly scorched, gradual scabbing requires no treatment. Both excessive delay and haste are inauspicious; one must distinguish between deficiency, toxicity, dampness, and fire patterns.
Clear fluid and tender skin indicate deficiency; redness, swelling, ulceration, and foul odor indicate toxic heat; fluid soaking indicates excess dampness; rapid scabbing with dry pits indicates fire scorching.
[Note]
Abundant fluid, mature color, slightly scorched apex, and sequential scabbing are all favorable progressions requiring no treatment.
"Too late" refers to failure to scab when expected.
"Too early" refers to premature scabbing when not expected. Neither is auspicious.
However, differentiation is required: it may be due to insufficiency, overwhelming toxicity, damp-fluid retention, or excess fire. Treatment must follow the syndrome.
For instance, clear fluid and tender skin belong to insufficiency; redness, swelling, ulceration, and foul odor belong to overwhelming toxicity difficult to resolve.
Fluid soaking belongs to excess dampness difficult to resolve.
Rapid scabbing with dry pits belongs to excess fire causing premature contraction. Practitioners must differentiate carefully.
Hui Jiang Yin (Return Fluid Decoction)
Tender skin, clear fluid, and delayed convergence indicate a deficiency pattern; treat according to insufficiency using Hui Jiang Yin: Ren Shen (Ginseng Radix), Huang Qin (Scutellariae Radix), Bai Zhu (Atractylodis Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Shou Wu (Polygoni Multiflori Radix), Bai Shao (Paeoniae Radix Alba), Zhi Huang Qi (Astragali Radix蜜-prepared).
[Note]
At the stage of convergence, if scabbing fails to occur, skin is tender, fluid is thin, accompanied by cool body temperature, cold extremities, and loose stools,
this is a deficiency syndrome due to original Qi insufficiency. Use Hui Jiang Yin to tonify and assist scab formation.
(Hui Jiang Yin) Ren Shen, Zhi Huang Qi (Astragali Radix honey-fried), Bai Fu Ling (Poria), Tu Chao Bai Zhu (Atractylodis Rhizoma soil-fried), Zhi Shou Wu (Polygoni Multiflori Radix prepared), Chao Bai Shao (Paeoniae Radix Alba fried), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma prepared).
Decoct with Wei Jiang (roasted ginger) water.
Da Liao Qiao Yin (Large Forsythia Decoction)
Redness, swelling, ulceration, and foul odor result from overwhelming toxicity; Da Liao Qiao Yin clears various heat pathogens. Ingredients include Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Che Qian Zi (Plantaginis Semen), Zhi Zi (Gardeniae Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma), Liao Qiao (Forsythiae Fructus), Niu Bang Zi (Arctii Fructus), Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), Chan Tui (Cicadae Periostracum), Hua Shi (Talcum), Tong Cao (Tetrapanacis Medulla).
[Note]
During the scabbing stage, some cases fail to converge due to overwhelming toxicity.
Symptoms include severe redness and swelling, ulceration with foul odor, high fever throughout the body, restlessness, thirst, and agitation, indicating massive toxic qi accumulation.
Use Da Liao Qiao Yin to resolve this.
(Da Liao Qiao Yin) Qu Xin Liao Qiao (Forsythiae Fructus, calyx removed), Fang Feng (Saposhnikoviae Radix), Chao Yan Niu Bang Zi (Arctii Fructus fried and crushed), Jing Jie (Schizonepetae Herba), Huang Qin (Scutellariae Radix), Dang Gui (Angelicae Sinensis Radix), Chan Tui (Cicadae Periostracum), Chai Hu (Bupleuri Radix), Hua Shi (Talcum), Zhi Zi (Gardeniae Fructus), Chi Shao (Paeoniae Radix Rubra), Che Qian Zi (Plantaginis Semen), Mu Tong (Akebiae Caulis), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma raw).
Decoct with Deng Xin Cao (Junci Medulla) water.
Chu Shi Tang (Dampness-Removing Decoction)
Whole-body oozing fluid indicates damp-fluid retention in the Spleen region. Chu Shi Tang contains Chi Fu Ling (Poria with Red Sac), Zhu Ling (Polyporus), Mu Tong (Akebiae Caulis), Ze Xie (Alismatis Rhizoma), Hou Gui (Cinnamomi Cortex tenuis), Cang Zhu (Atractylodis Rhizoma), Fang Feng (Saposhnikoviae Radix), Bai Zhu (Atractylodis Rhizoma), Qiang Huo (Notopterygii Rhizoma et Radix).
[Note]
During the scabbing stage, some cases fail to converge due to excess dampness.
Mild cases show weeping pores; severe cases exhibit whole-body ulceration, abdominal distension, and scanty urine, all caused by damp-fluid pathology.
Use Chu Shi Tang to promote diuresis and remove dampness; once dampness is eliminated, scabbing will occur naturally.
(Chu Shi Tang)
Qiang Huo (Notopterygii Rhizoma et Radix), Mi Jiang Shui Jin Chao Cang Zhu (Atractylodis Rhizoma soaked in rice wash water and fried), Fang Feng (Saposhnikoviae Radix), Chi Shao (Paeoniae Radix Rubra), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Shang Chao Bai Zhu (Atractylodis Rhizoma stir-fried), Mu Tong (Akebiae Caulis), Hou Gui (Cinnamomi Cortex tenuis).
Decoct with Sheng Jiang (Fresh Ginger) and Deng Xin Cao (Junci Medulla) water.
Qing Du San (Toxin-Clearing Powder)
Rapid scabbing is caused by fire injury; whole-body pits are abnormally dry. Qing Du San contains Dang Gui (Angelicae Sinensis Radix), Chi Shao (Paeoniae Radix Rubra), Lian Qiao (Forsythiae Fructus), Dan Pi (Moutan Cortex), Gan Cao (Glycyrrhizae Radix et Rhizoma), Lian Qiao (Forsythiae Fructus), Niu Bang Zi (Arctii Fructus), Mu Tong (Akebiae Caulis), Hua Sheng (Arachidis Hypogaea Semen), Sheng Di (Rehmanniae Radix).
[Note]
When scabbing occurs prematurely at an inappropriate time,
accompanied by dry, parched pustules throughout the body, thirst, fever, and irritability, this is due to congested and excessive toxic fire.
Use Qing Du San as the primary treatment.
(Qing Du San) Sheng Di (Rehmanniae Radix), Chi Shao (Paeoniae Radix Rubra), Qu Xin Lian Qiao (Forsythiae Fructus, calyx removed), Jin Yin Hua (Lonicerae Japonicae Flos), Chao Yan Niu Bang Zi (Arctii Fructus fried and crushed), Mu Tong (Akebiae Caulis), Huang Lian (Coptidis Rhizoma), Dang Gui (Angelicae Sinensis Radix), Dan Pi (Moutan Cortex), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma raw).
Decoct in water.