【瘢赤黑】〔万〕疮痂落后，其面瘢或赤或黑者，用四白灭瘢散，临睡以清蜜水
调搽面上，至晓以水涤去之，自然白莹，脱去更宜爱护，不得早见风日，经年不灭。如疮瘢突起成凸者，此热毒未
尽，解毒防风汤主之（见形发热），外更用蚬子内水摩之。如陷下成凹者，此脾胃虚不能长肌肉也，人参白术散（痘渴）
加黄 主之。
四白灭瘢散
白芷 白附子 白僵蚕 鹰矢 白密陀僧（各等分）
共研极细末。以水调搽面 ，神效。
韶粉散 治痘疮才愈，毒瓦斯未尽，疮痂虽落，其瘢犹黯，或凸凹肉起，当用此药涂之。
韶粉（一两） 轻粉（一钱）
上研细末。猪骨髓熬熟调成膏，薄涂疮瘢上。如痘疹欲落，当灭瘢痕，一名灭瘢散。
【瘢黑暗】凡疮瘢头面浑身并黑暗者，未可便说无事，犹恐日前未甚作脓，收靥太急，此倒靥归肾也。但察其表里，
如壮热大渴未除，烦闷昏睡少食，或大便不通，或自利，此真倒靥归肾也，若身温暖爽快，食渐加，大小便调者，
此疮瘢本色，无虑也。
【痂不脱】〔万〕痘疮收后，其痂自脱者佳，不脱，以百花膏润之，令其速脱，稍迟则干硬，深入肌肉，经久方脱，
遂成瘢痕。然久而不脱者，脾胃虚也，人参白术散加黄 、官桂主之，不可 掐剥去，若不禁手，反伤皮肤，
复灌作疮，番覆溃烂，一时难愈，其后多成疥癞也。〔黄〕痘疮粘着皮肉，不肯脱落，此表虚也，尤
当禁忌，以防异变，用调元固表汤主之。
调元固表汤
黄 人参 当归 甘草 蝉蜕
人参固肌汤 治痘表发太过，致肌肉不密，痘痂粘肉，久不落者。
人参 黄 甘草 当归 蝉蜕（各等分） 糯米（一撮）
上，用水煎服。
人参清神汤 治痘痂不落，昏迷沉睡者。
人参 黄 甘草 当归 白术（土炒） 麦门冬 陈皮 酸枣仁 黄连（酒炒） 茯苓
上，各等分，加枣子、糯米，水煎服。
马齿苋散 治痘痂不落，成 痕者。
马齿苋（捣汁） 猪脂膏 石蜜
三味共熬成膏，涂肿处。
凡疮痂日久，当脱不脱者，胸背手足无妨，惟面上不脱，必成瘢陷，未脱者以
百花膏润之（收靥），令其易脱，脱尽之后，瘢痕黑黯者，以四白灭瘢散涂之。
羊 骨髓 治痘痂欲落不落，瘢痕。
羊 骨髓一两，炼入轻粉一钱，研成膏，涂之。
如收靥既迟，疮痂不落，昏昏喜睡者，此邪气已退，正气未复，脾胃虚弱，宜调元汤（即参 饮见
大法）加麦门冬，合安神丸（痘烦躁）。或只用酸枣仁汤（烦躁）缓缓调理，待气血平复，荣卫和畅而安矣。
【瘢肿成脓】痘疮收靥之后，痂皮尽脱，曾见瘢痕凸起，复作脓窠，依旧结一层 子者，或因收靥太
骤，毒瓦斯未尽，或因误服温补之药，多啖肥甘之物，饮酒喜食煎炒辛热，或因出风太早，荣卫郁而不通，皆
能复成此证，亦与前日一般，但无苦耳，若此者，毒邪外散，决无留毒之患。痘疮遍身溃烂不结痂者，倒靥也。或三
五处肿灌溃烂，不结痂者，疳蚀疮也。若已正靥，痂起自脱。或面上，或手足，或片结硬疮，头虽焦，中蓄脓浆者，
此是原出疮子之初，其处太密，糊涂成片，无复颗粒，所以毒壅于里，不能起发作脓结痂也，但用灭瘢救苦散（收靥）
和百花膏（收靥）涂之，待脓尽痂起自愈。或手足腕膝之间，疮窠连串作大一块，脓化作水，停蓄于中，恰
如囊袋，皮不破，水不去，日久只如是者，此里面肌肉已好，原日疮皮、剩于外也，宜用针决去其水，自干脱矣。
【能食不能食】疮痂既落，中气暴虚，多不能食，必藉人参白术散去葛根，加陈皮、木香、以调养之。其间或有疮
痂起而能食者，是胃中宿有蕴热故也，盖胃热则消谷，所以能食，其人必大便稍秘，或大便难，当用三黄丸利之，
否则恐胃热不去，郁为口臭，齿腐生风之证，流散四肢，则发为痈疽肿毒。然有一等脾胃素壮
实者，平素能食，大便亦不至有秘结之患，此又不可一概论也。
【瘢痕赤白】痘痕赤白，各有所因，治法亦异。凡痕赤而作痒，血虚而有热也，
用四味牡丹皮。赤而作痛，余热也，用四君、连翘、金银花。若发热而大便调和者，
脾胃虚热也，用五味异功散。若发热而大便秘结者，肠胃内热也，用《圣济》犀角地黄汤。若母有肝火，用加味
逍遥散。若母有郁怒，用加味归脾汤，佐以加味逍遥散治之。白者 属气虚而血衰也，宜固元气为本。痒而作渴者，
气血俱虚也，十全大补汤之类。乳食减少，四肢倦怠者，中气虚也，五味异功散之类。气虚发热者，
补中益气汤之类。血虚发热者，当归补血汤之类。须参兼变之证治之。此证若服药而渐红活者可治，色不转者不治，
虽经年后多患泻利而死，若妄投攻伐，祸在反掌。一小儿痘疮如期而愈，痕赤如赭。余谓此乳母有热也，诊之，果
有肝脾郁火，先用加味逍遥散四剂，与母服之，子各饮少许而并愈。一小儿痘痕色赤作痛，热渴喜
冷，大便不利。先用前胡枳壳散，便利渴止，再用《圣济》犀角地黄汤而安，又用芹菜汁而靥。一小儿十六岁，痘痕白，
用独参汤数斤，色渐如旧，又用地黄丸、大补汤、而安。
【禁忌】痘疮新瘥之后，气血未复，视之未靥，尤加调护可也。盖痂皮起落，肌肉新嫩，不宜澡洗，增减衣服则表
已虚，寒暑之气易袭也。疮毒内作，脏腑俱伤，毒虽外散，肠胃已弱，不宜饮冷，伤饥过饱则里气虚，饮食之物易
伤也，时俗不知此理，谓之已痊，再无他变，怠玩纵弛，致生后灾，一旦病生，悔之晚矣。
【 杌痘】〔袁〕按∶孙氏揭 杌痘以垂世，而不注解其详，迨黄石峰尽注明白。且痘澄脓结痂，自头抵足，
靥已脱矣，又身发火热，旧靥盆处，重出一番痘，疏囊聚脓，痛愈加甚，服药调护，庶免夭亡，倘饮食不节，风寒不
避，邪气感迫，囊破溃烂，肚腹渐胀，阴阳不分，死在旦夕矣。若起于头面者，须防陋井涌泉（陋井、腮颊穿陋，
涌泉、眼沿陋）。之患，起于背腹者，应虑蜂螫沉石之虑（蜂螫，遍身刺痛也，沉石，皮肉四烂也），起于手足者，
不免有罄笔之罹，起于阳球者，预宜防脱囊之害。玉函云∶天花结果庆奇全， 杌归门痘倒颠，不是渠塘番汹浪，
便教关节结痈缠。为父母者，庶几慎之。
[Scar Red and Black] [Wan] After the scabs of smallpox fall off, if the scars on the face are red or black, apply Sibai Mieban San (Four Whites Scar-Removing Powder). Mix with clear honey water before sleep, rub onto the face, and wash off with water at dawn. Naturally, it will become white and lustrous. After the scab falls off, extra care should be taken to avoid exposure to wind and sunlight early on; even if the scar does not fade after a year, it is acceptable. If the scar protrudes and becomes convex, this indicates that heat-toxin has not been fully cleared; treat primarily with Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) (see "Shape Fever"), and externally rub with the inner water of clam shells. If the scar is depressed and concave, this is due to Spleen-Stomach deficiency failing to regenerate muscle tissue; treat primarily with Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) (see "Smallpox Thirst") plus Huangqi (Astragalus Root).
Sibai Mieban San (Four Whites Scar-Removing Powder)
Baizhi (Angelicae Dahuricae Radix), Baifuzi (Aconiti Kusnezoffii Radix), Baijiangcan (Bombyx Batryticatus), Yingshibai (Columbae Excrement Album), Baimituoseng (Lithargyri Preparatum) (equal parts)
Grind into an extremely fine powder. Mix with water and apply to the face; miraculous effect.
Shaofen San (Pearl White Powder) Treats cases where smallpox has just healed, but toxin remains. Although scabs have fallen, scars remain dark, or there are凹凸 (concavities and convexities) with raised flesh. Apply this medicine topically.
Shaofen (1 liang), Qingfen (Calomel, 1 qian)
Grind into fine powder. Cook pig marrow into a paste and mix with the powder. Apply thinly to the scars. If vesicles are about to fall and one wishes to eliminate scars, this is also known as Mieban San (Scar-Removing Powder).
[Dark Scars] Whenever scars on the head, face, and whole body appear dark, do not immediately assume there is no problem. It is feared that previously pus formation was insufficient and the healing/crusting (Shouye) was too rapid, indicating "Dao Ye Gui Shen" (Inverse Crusting Returning to Kidney). Observe the exterior and interior conditions: if there is high fever and severe thirst unrelieved, restlessness, drowsiness, and poor appetite, or constipation, or spontaneous diarrhea, this is true "Dao Ye Gui Shen". If the body feels warm and comfortable, food intake gradually increases, and bowel/bladder movements are normal, this is the natural color of the scar; no need to worry.
[Scabs Not Falling Off] [Wan] After smallpox收敛 (recedes/heals), it is auspicious for scabs to fall off naturally. If they do not fall off, use Baihua Gao (Hundred Flowers Ointment) to moisten them, allowing them to fall off quickly. Delaying causes them to become dry and hard, penetrating deep into the muscle, taking a long time to fall off, eventually forming scars. However, if they remain for a long time without falling, it is due to Spleen-Stomach deficiency; treat primarily with Renshen Baizhu San plus Huangqi (Astragalus Root) and Guigui (Cinnamon Twig). Do not pick or peel them off by hand; if one cannot resist picking, it damages the skin, leading to reinfection and suppuration, repeated ulceration, difficult healing, and potentially resulting in scabies-like conditions later. [Huang] Smallpox scabs adhering to the skin and refusing to fall off indicate Exterior Deficiency. One must strictly observe taboos to prevent abnormal changes; treat primarily with Tiaoyuan Gubiao Tang (Regulate Origin and Secure Exterior Decoction).
Tiaoyuan Gubiao Tang (Regulate Origin and Secure Exterior Decoction)
Huangqi (Astragali Radix), Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Chantui (Cicadae Periostracum)
Renshen Guji Tang (Ginseng Solidify Muscle Decoction) Treats cases where the exterior was dispersed too excessively during smallpox, causing loose muscle tissue, adhesion of scabs to flesh, and prolonged non-falling of scabs.
Renshen (Ginseng Radix), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Chantui (Cicadae Periostracum) (equal parts), Nuomi (Glutinous Rice, a handful)
Decoct in water and take orally.
Renshen Qingshen Tang (Ginseng Clear Spirit Decoction) Treats cases where scabs do not fall off, accompanied by coma and deep sleep.
Renshen (Ginseng Radix), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma - soil-fried), Maimendong (Ophiopogonis Radix), Chenpi (Citri Reticulatae Pericarpium), Suanzaoren (Ziziphi Spinosae Semen), Huanglian (Coptidis Rhizoma - wine-fried), Fuling (Poria)
Equal parts, add dates and glutinous rice, decoct in water and take orally.
Machixian San (Portulaca Powder) Treats cases where scabs do not fall off and scars form.
Machixian (Portulacae Herba - crushed for juice), Zhizhi Gao (Pork Lard Ointment), Shimii (Rock Sugar)
Boil the three ingredients together into an ointment and apply to swollen areas.
For any scabs that have been present for a long time and should fall off but do not: those on the chest, back, hands, and feet are not problematic. Only those on the face will inevitably form depressed scars. Moisten the unfallen scabs with Baihua Gao (Hundred Flowers Ointment) (see "Healing/Crusting") to facilitate falling off. After complete removal, if scars are dark/black, apply Sibai Mieban San.
She Marrow Treats smallpox scabs that want to fall off but do not, and scars.
She Marrow (1 liang), refined with Qingfen (Calomel, 1 qian), ground into an ointment, apply topically.
If healing/crusting is delayed, scabs do not fall off, and the patient is drowsy and sleepy, this indicates pathogenic qi has retreated but healthy qi has not yet recovered, and Spleen-Stomach is weak. Use Tiaoyuan Tang (i.e., Shenling Yin, see General Principles) plus Maimendong (Ophiopogonis Radix), combined with Anshen Wan (Calm Spirit Pill) (see "Smallpox Irritability"). Or simply use Suanzaoren Tang (Jujube Seed Decoction) (see "Irritability") for slow regulation, waiting for Qi and Blood to stabilize and Ying-Wei (Nutritive and Defensive Qi) to harmonize before peace is restored.
[Scar Swelling and Suppuration] After smallpox healing/crusting, when all scabs have fallen, sometimes scars protrude and turn into pustules again, forming a new layer of crust. This may be due to healing being too rapid with residual toxin, or mistakenly taking warming/tonifying medicines, consuming too much rich/greasy food, drinking alcohol, liking fried/spicy/hot foods, or exposing to wind too early, causing Ying-Wei stagnation and blockage. All can lead to this condition again. It is similar to previous days but without pain. In such cases, pathogenic toxins disperse outward, so there is no risk of retained toxin. If smallpox ulcers all over the body fail to crust, it is "Dao Ye" (Inverse Crusting). If only 3-5 areas swell, suppurate, and ulcerate without crusting, it is "Gan Shi Chuang" (Kwashiorkor-like Ulcer). If proper crusting has occurred and scabs fall off naturally, or if on the face, hands, feet, or成片 (in patches) hard crusts form with burnt heads but pus accumulation inside, this is because the original pustules were too dense, merging into a mass without distinct grains, causing toxin congestion internally, preventing pus formation and crusting. Apply Mieban Jiuku San (Scar-Removing and Bitterness-Saving Powder) mixed with Baihua Gao (Hundred Flowers Ointment) until pus drains and scabs rise, then it heals itself. If between wrists/knees, pustules merge into a large mass, turning to fluid, accumulating like a sac without breaking skin, persisting for days, this indicates internal muscle has healed, leaving old skin outside. Puncture with a needle to drain fluid, and it will dry and fall off naturally.
[Able vs. Unable to Eat] After scabs fall off, Middle Qi suddenly becomes deficient, often leading to inability to eat. One must rely on Renshen Baizhu San minus Gegen (Puerariae Radix), plus Chenpi (Citri Reticulatae Pericarpium) and Muxiang (Aucklandiae Radix) for nourishment. Occasionally, some have rising scabs but can still eat; this is due to latent heat in the Stomach. Stomach Heat promotes digestion, hence the ability to eat. Such patients usually have slight constipation or difficulty defecating. Treat with Sanhuang Wan (Three Yellows Pill) to purge. Otherwise, Stomach Heat may linger, becoming halitosis, rotting teeth, or wind-generation syndromes, spreading to limbs causing carbuncles and toxic swellings. However, those with strong constitutions who normally eat well and have no constipation issues cannot be generalized in this manner.
[Red and White Scars] Red and white smallpox scars have different causes and treatments. Red scars with itching indicate Blood Deficiency with Heat; use Siwei Mudan Pi (Four Ingredients Moutan Bark). Red scars with pain indicate residual heat; use Sijunzi Tang (Four Gentlemen Decoction), Lianqiao (Forsythiae Fructus), and Jinyinhua (Lonicerae Japonicae Flos). If fever accompanies normal bowel movements, it is Spleen-Stomach Deficient Heat; use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder). If fever accompanies constipation, it is Intestinal-Stomach Internal Heat; use Shengji Juexiao Dihuang Tang (Star-Rhino-Horn Rehmannia Decoction from Shengji Tongpu). If the mother has Liver Fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If the mother has depression/anger, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction), assisted by Jiawei Xiaoyao San. White scars belong to Qi Deficiency and Blood Decline; prioritize securing Original Qi. Itching with thirst indicates Qi and Blood both deficient; use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) etc. Reduced milk/food intake and limb fatigue indicate Middle Qi Deficiency; use Wuwei Yigong San etc. Qi Deficiency with fever: Buchong Yiqi Tang (Tonify Middle and Augment Qi Decoction) etc. Blood Deficiency with fever: Danggui Buxue Tang (Angelica Tonify Blood Decoction) etc. Must consider concurrent/variable syndromes. If symptoms improve and become ruddy/red after medication, it is treatable; if color does not change, it is untreatable, and death from diarrhea may occur years later. Reckless use of purging/attacking drugs brings disaster instantly. A child's smallpox healed on schedule, leaving red-as-hematite scars. I reasoned this was due to maternal heat. Diagnosis confirmed Liver-Spleen Depressed Fire. First gave Jiawei Xiaoyao San (4 doses) to the mother; the child drank a little, and both recovered. Another child had red, painful scars, fever/thirst preferring cold, and constipation. First used Qianhu Zhike San (Peucedanum and Aurantium Powder); once bowels moved and thirst stopped, used Shengji Juexiao Dihuang Tang to calm, then celery juice to heal. A 16-year-old child had white scars; used Dushen Tang (Single Ginseng Decoction) for several jin, color gradually returned to normal, then used Dihuang Wan (Rehmannia Pill) and Dabu Tang (Great Tonifying Decoction) to recover.
[Taboos] After recent smallpox recovery, Qi and Blood are not yet restored. Even if visually healed, extra care is essential. As scabs rise and fall, new muscle tissue is tender; bathing is inadvisable. Changing clothes exposes the weakened Exterior to Cold/Heat pathogens. Toxin acts internally, damaging Zang-Fu organs. Although toxin disperses outward, intestines/stomach are weak; cold drinks are inadvisable. Hunger or overeating weakens Interior Qi, making food hard to digest. Laypeople ignore this, calling it "fully cured" with no further risks, leading to negligence and subsequent disasters. Once illness strikes, regret comes too late.
[Ni Dou / Reverse Smallpox] [Yuan] Note: Sun Shi revealed Ni Dou for transmission but did not annotate details in depth; Huang Shifeng clarified everything. When pus clears and scabs form from head to toe, and crusts have fallen, yet fever arises again, and new smallpox erupts at old crust sites, with sparse sacs gathering pus and increasing pain, medication and care may prevent premature death. If diet is irregular and wind-cold avoided poorly, pathogenic qi forces invasion, sacs break and ulcerate, abdomen swells, Yin/Yang separate, and death occurs within a day. If arising on the head/face, fear "Lou Jing Yong Quan" (Lou Jing: cheek perforation; Yong Quan: eye margin perforation). If on back/abdomen, fear "Feng Zhe Chen Shi" (Feng Zhe: whole-body stabbing pain; Chen Shi: four-sided rot of skin/flesh). If on hands/feet, suffer endless suffering. If on genitals, fear testicular detachment. Yu Han says: "Celestial flowers bear fruit, celebrating miraculous completion; Ni Dou returns to the gate, smallpox inverted. Not channel pond waves surging, but joints knotting into carbuncles缠绕." Parents should be cautious.