顺证结痂吹序脱，瘢瘕润满色红活，额膝迟落不足虑，阴阳相济自然脱。
[注]
结痂顺证，谓痘结痂根据次序而脱落也，
瘢疽润满者，谓瘢痕润而不燥，满而不陷也，
红活者，谓瘢痕不赤而色红活也，
若涸身之痂落尽，而额膝迟落者，不足虑也，
盖头额谓孤阳，脚膝为孤阴，必待阴阳相济而痂自落矣。
%
险证结痂不尽脱，瘢痕干燥少红活，余毒痕色多紫黯，痘后必发火疡疖。
[注]
结痂险证，谓痘结痂不尽脱也，
瘢痕干燥者，谓瘢痕不润泽也，以上二证，固属险证，
若饮食强美，二便调和，虽险不足虑也，
余毒者，谓痘后余毒未尽解也，
其色紫黯者，乃余毒之热留于血分也，
疡疖者，谓其毒留久必发痘毒火疮也。
%
逆证结痂痂不脱，痂脱疽色白不红，痘盘光紫或枯黯，气乏形羸何以生。
[注]
结痂逆证，谓痘结痂日久不脱也，痂已脱落，
其瘢色纯白不红，此血脱虚甚也，
痘盘光紫者，谓痘痕浮光色紫，此毒焰外炽也，
枯黯者，谓痘痕干枮黑黯，此毒锢血死也，
气乏形羸者，谓痘落痂之后，其儿元气虚乏，形羸难支，将何恃以生也。
%
痂厚光泽如粟色，痂落瘢红润满平，干燥不落血分热，过痂浸淫湿所乘，
半掀半连肌表热，瘢紫黑焦毒末清，色赤凸起为风热，色白凹陷是虚形。
[注]
痂厚光润如粟色者，谓结痂厚而不薄，不干不湿，不黑不白，如粟壳色，
痂落瘢红润满平者，谓痂落瘢痕色红润泽，
平满不凸不凹，皆结痂落痂顺痘也，
痂干燥不落者，乃血分热也，
围痂浸淫，乃湿邪也，
半掀半连，乃肌表热也，
瘢紫黑焦，乃毒末清也，
若赤而凸起，乃风热盛也，
白而凹陷，乃气血虚也，
治者须详辨之
%
凉血解毒汤
结痂干燥不润泽，难落须知血分热，凉血解毒归地紫，丹红翘芷连甘枯。
[注]
痘至结痂之后，当落不落者，
现证干燥不润，根色红艳，渴欲饮冷，烦急不宁，
此毒热郁于血分故也，宜用凉血解毒汤主之，热清而痂自落矣。
(凉血解毒汤) 当归 生地黄 紫草 丹皮 红花 连翘去心 白芷
川黄连 甘草生 枯梗 引加灯心水煎服。
%
五苓散
结后根脚漏水浆，甚则溃烂乃湿伤，五苓散中猪泽桂，茯苓白术更相当。
[注]
痘当已结未落之时，根脚浸漏水浆，甚则过身溃烂，小水短涩，大便溏泄，
此湿胜浸淫之故也，宜用五苓散分利之，湿除而痂自落矣。
(五苓散) 猪苓 泽泻 肉桂 茯苓 白术土炒 引加灯心水煎服。
%
荆防解毒汤
半掀半连因表热，似落不落势缠绵，荆防解毒芍地草，金银通桔骨翘攒。
[注]
痘当落痂之后，宜落不落，其痂一半掀起，一半咬紧，
现证身热干燥，肌肤红赤，此热在肌表之证，宜荆防解毒汤主之。
(荆防解毒汤)
荆芥 防风 赤芍药 生地黄 甘草生 金银花 木通 桔梗
地骨皮 连翘去心 引加生姜水煎服。
%
黄连解毒加味汤
痂落瘢紫黑与焦，毒热郁结未曾消，解毒芩连栀子蘖，加丹生地草金翘。
[注]
痘当落痂之后，其瘢或紫或焦或黑，
现证通身壮热，烦渴不宁，
皆因灌溉时浆未充足，毒气未尽化故也，
均宜黄连解毒汤加生地，连翘，丹皮，金银花，甘草主之。
(黄连解毒加味汤)
黄连 黄芩 栀子 黄蘖 丹皮 生地黄 甘草生 金银花 连翘去心
引加灯心水煎服。
%
解毒防风汤
落后瘢赤作肿形，内热未解复受风，解毒黄芩生地草，翘蒡荆防金芍升。
[注]
痘当落痂之后，瘢凸不干，色赤而艳，或发热或作痒，皆血有余热，
复外感于风故也，宜解毒防风汤主之。
(解毒防风汤)
黄芩 生地黄 甘草 连翘去心 牛蒡子炒研 荆芥 防风 金银花 赤芍
升麻 引加生姜水煎服。
%
十全大补汤
落痂凹陷最可虑，色白形羸气血虚，大补参苓白术草，归芎芍地桂黄耆。
[注]
痘当落痂之后，其瘢凹而不起，色白不红，
现证精神倦软，饮食懒少，
此气血两虚之证也，宜十全大补汤主之。
(十全大补汤) 人参 茯苓 白术土炙 甘草炙 当归 川芎 白芍炒
熟地黄 肉桂 黄耆蜜炙 引加煨姜水煎服。
%
Smooth progression: Scabs fall off in sequence; the resulting scars are moist, full, and ruddy. Delayed shedding on the forehead and knees is not a concern, as the mutual balance of Yin and Yang ensures natural detachment.
[Note]
Smooth progression of scabbing refers to the orderly shedding of pox scabs.
Moist and full scars indicate that the scar tissue is hydrated rather than dry, and plump rather than depressed.
Ruddy vitality indicates that the scar tissue is not hyperemic but possesses a healthy, vibrant red color.
If the scabs on the rest of the body have completely fallen off, but those on the forehead and knees remain for a longer time, there is no need for worry.
This is because the head and forehead represent solitary Yang, while the feet and knees represent solitary Yin; the scabs will naturally fall only after Yin and Yang achieve mutual support.
Dangerous progression: Scabs fail to shed completely; scars are dry with little ruddiness. Residual toxins often leave scars purple and dark; post-pox fire sores and boils will inevitably occur.
[Note]
Dangerous progression of scabbing refers to the incomplete shedding of pox scabs.
Dry scars indicate a lack of moisture and lubrication. Although these two conditions belong to dangerous progressions, if the patient's diet is robust and good, and urination and defecation are harmonious, even a dangerous progression need not be feared.
Residual toxin refers to the pathogenic factors remaining after the pox eruption that have not been fully cleared.
Purple and dark colors indicate that residual heat remains in the blood level.
Sores and boils refer to the manifestation of lingering toxins as fire carbuncles (purulent infections).
Adverse progression: Scabs do not shed; after shedding, scars are white and not ruddy. Pox bases appear lustrous purple or withered and dark. With depleted Qi and emaciated form, how can life be sustained?
[Note]
Adverse progression of scabbing refers to pox scabs failing to shed after a long duration. After the scabs have fallen,
purely white scars without ruddiness indicate severe blood depletion and deficiency.
Lustrous purple pox bases indicate floating gloss and purple discoloration, signifying outward blazing of toxic flames.
Withered and dark scars indicate dryness, roughness, and blackish darkness, signifying toxin entrapment and stagnant, dead blood.
Depleted Qi and emaciated form indicate that after the pox falls and scabs shed, the child's primordial Qi is deficient, and the physical form is too weak to sustain itself; upon what basis can life continue?
Thick, glossy scabs resembling millet husk color; after shedding, scars are ruddy, moist, full, and flat. Dryness preventing shedding indicates heat in the Blood level. Oozing around scabs indicates invasion by Dampness.
Half-lifted, half-adherent scabs indicate heat at the Muscle-Wei level. Purple, black, or scorched scars indicate uncleared toxins. Red and raised scars indicate Wind-Heat. White and depressed scars indicate deficiency patterns.
[Note]
Thick, glossy scabs resembling millet husk color means the scabs are thick rather than thin, neither dry nor wet, neither black nor white, like the color of millet husks.
Scars that are ruddy, moist, full, and flat after scab shedding mean the scar tissue is red, lustrous, smooth, and full without protrusion or depression; these are all smooth cases of scab formation and shedding.
Dry scabs that do not shed indicate Heat in the Blood level.
Oozing around the scabs indicates invasion by Damp pathogenic factors.
Half-lifted and half-adherent indicates Heat at the Muscle-Wei level.
Purple, black, and scorched scars indicate uncleared toxins.
Red and raised scars indicate excess Wind-Heat.
White and depressed scars indicate Qi and Blood deficiency.
Practitioners must distinguish these carefully.
Cool Blood and Detoxify Decoction (Liangxue Jiedu Tang)
Scabs are dry and unmoistened; difficulty in shedding indicates Heat in the Blood level. Cool Blood and Detoxify uses Angelica, Rehmannia, Arnebia, Moutan, Safflower, Forsythia, Angelica dahurica, Coptis, Licorice, and Platycodon.
[Note]
After the pox reaches the scabbing stage, if scabs should shed but do not,
and present symptoms include dryness without moisture, bright red roots, thirst for cold drinks, and irritability/restlessness,
this is due to toxic heat stagnating in the Blood level. It is appropriate to use Cool Blood and Detoxify Decoction as the main treatment. Once the heat clears, the scabs will naturally shed.
(Cool Blood and Detoxify Decoction) Radix Angelicae Sinensis (Danggui), Radix Rehmanniae Preparata (Shengdihuang), Herba Arnebiae (Zicao), Cortex Moutan (Danpi), Flos Carthami (Honghua), Fructus Forsythiae (Lianqiao, heart removed), Radix Angelicae Dahuricae (Baizhi), Rhizoma Coptidis (Chuanhuanglian), Radix Glycyrrhizae (Gancao, raw), Radix Platycodonis (Jiegeng). Add Nux Junci (Dengxincao) as a guide, decoct in water and take orally.
Wu Ling San (Five-Ingredient Powder with Poria)
After scabbing, fluid leaks from the base; severe cases involve ulceration due to Damp injury. Wu Ling San contains Polyporus, Alisma, Cinnamon, Poria, and Atractylodes.
[Note]
When the pox has formed scabs but they have not yet shed, if fluid leaks from the base, or even progresses to whole-body ulceration, accompanied by scanty, difficult urination and loose stools,
this is caused by excessive Dampness invading. It is appropriate to use Wu Ling San to separate and drain the Dampness. Once the Dampness is removed, the scabs will naturally shed.
(Wu Ling San) Polypori Umbellatum (Zhuling), Alismatis Rhizoma (Zexie), Cinnamomi Ramulus (Rougui), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Baizhu, stir-fried with soil). Add Nux Junci (Dengxincao) as a guide, decoct in water and take orally.
Jing Fang Jiedu Tang (Schizonepeta and Saposhnikovia Decoction to Clear Toxins)
Half-lifted, half-adherent due to exterior heat; seemingly shedding but lingering. Jing Fang Jiedu Tang uses Schizonepeta, Saposhnikovia, Peony, Rehmannia, Licorice, Honeysuckle, Akebia, Platycodon, Lycium bark, and Forsythia.
[Note]
After the pox should shed its scabs, if it fails to do so, with half the scab lifted and half tightly adherent,
and presenting symptoms of body heat, dryness, and reddish skin,
this is a pattern of Heat at the Muscle-Wei level. It is appropriate to use Jing Fang Jiedu Tang as the main treatment.
(Jing Fang Jiedu Tang) Herba Schizonepetae (Jingjie), Radix Saposhnikoviae (Fangfeng), Radix Paeoniae Rubra (Chishaoyao), Radix Rehmanniae Preparata (Shengdihuang), Radix Glycyrrhizae (Gancao, raw), Flos Lonicerae (Jinyinhua), Caulis Akebiae (Mutong), Radix Platycodonis (Jiegeng), Cortex Lycii (Digupi), Fructus Forsythiae (Lianqiao, heart removed). Add Zingiberis Rhizoma Recens (Shengjiang) as a guide, decoct in water and take orally.
Huanglian Jiedu Tang Modified (Coptis Decoction to Clear Toxins, Modified)
After scab shedding, scars are purple, black, or scorched; toxic heat stagnates and has not dissipated. Clear toxins with Scutellaria, Coptis, Gardenia, and Phellodendron; add Moutan, Rehmannia, Licorice, Honeysuckle, and Forsythia.
[Note]
After the pox sheds its scabs, if the scars are purple, scorched, or black,
and presenting symptoms include high fever throughout the body, irritability, thirst, and restlessness,
this is because the filling stage lacked sufficient fluid, and the toxic qi was not fully transformed.
All such cases should be treated with Huanglian Jiedu Tang modified with Shengdi, Lianqiao, Danpi, Jinyinhua, and Gancao.
(Huanglian Jiedu Tang Modified) Rhizoma Coptidis (Huanglian), Radix Scutellariae (Huangqin), Fructus Gardeniae (Zhizi), Cortex Phellodendri (Huangbai), Cortex Moutan (Danpi), Radix Rehmanniae Preparata (Shengdihuang), Radix Glycyrrhizae (Gancao, raw), Flos Lonicerae (Jinyinhua), Fructus Forsythiae (Lianqiao, heart removed). Add Nux Junci (Dengxincao) as a guide, decoct in water and take orally.
Jiedu Fangfeng Tang (Detoxify and Saposhnikovia Decoction)
After shedding, scars are red and swollen; internal heat unresolved, compounded by Wind exposure. Detoxify with Scutellaria, Rehmannia, Licorice; add Forsythia, Arctium, Schizonepeta, Saposhnikovia, Honeysuckle, Peony, and Cimicifuga.
[Note]
After the pox sheds its scabs, if scars are raised and dry, red and bright, or accompanied by fever or itching,
these indicate excess Heat in the Blood,
compounded by external Wind exposure. It is appropriate to use Jiedu Fangfeng Tang as the main treatment.
(Jiedu Fangfeng Tang) Radix Scutellariae (Huangqin), Radix Rehmanniae Preparata (Shengdihuang), Radix Glycyrrhizae (Gancao), Fructus Forsythiae (Lianqiao, heart removed), Fructus Arctii (Niubangzi, stir-fried and crushed), Herba Schizonepetae (Jingjie), Radix Saposhnikoviae (Fangfeng), Flos Lonicerae (Jinyinhua), Radix Paeoniae Rubra (Chishao), Rhizoma Cimicifugae (Shengma). Add Zingiberis Rhizoma Recens (Shengjiang) as a guide, decoct in water and take orally.
Shiquan Dabu Tang (Complete Great Tonifying Decoction)
Depression after scab shedding is most concerning; white color and emaciation indicate Qi and Blood deficiency. Tonify with Ginseng, Poria, Atractylodes, Licorice; add Angelica, Ligusticum, Peony, Rehmannia, Cinnamon, and Astragalus.
[Note]
After the pox sheds its scabs, if scars are depressed and do not rise, and are white without ruddiness,
and presenting symptoms include mental fatigue, weakness, poor appetite, and reduced food intake,
this is a pattern of dual deficiency of Qi and Blood. It is appropriate to use Shiquan Dabu Tang as the main treatment.
(Shiquan Dabu Tang) Radix Ginseng (Renshen), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Baizhu, stir-fried with soil), Radix Glycyrrhizae (Gancao, honey-fried), Radix Angelicae Sinensis (Danggui), Rhizoma Chuanxiong (Chuanxiong), Radix Paeoniae Alba (Baishao, stir-fried), Radix Rehmanniae Preparata (Shudihuang), Cinnamomi Ramulus (Rougui), Radix Astragali (Huangqi, honey-fried). Add Zingiberis Rhizoma Ustun (Weijiang) as a guide, decoct in water and take orally.