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Scabbing from smallpox should naturally fall off according to the course of the disease. Those that should fall off but do not, or those that linger for a long time, must be carefully examined and treated to prevent other complications.

1. If scabs adhere to the flesh after half a month or a month without falling off, or if itching occurs, this is necessarily due to excessive dispersing (sweating), which has damaged body fluids (Jin-Ye), leading to deficiency and dryness in the Cou-Li (skin texture and pores), resulting in a lack of strength to shed them. It is appropriate to use Renshen Guji Tang (Ginseng Muscle-Securing Decoction) or to moisten with genuine butter oil or sesame oil. If they remain for a long time without shedding, Liuwu Jian (Six-Ingredient Decoction) added with Huangbai (Phellodendron Bark), Rougui (Cinnamon Bark), and Chantui (Cicada Slough) should be used as the main treatment. Do not forcibly peel them off, lest skin damage occur, making healing difficult in a short time.

2. Although scabs cover the whole body, if residual heat remains unsubsided and accumulates in the muscle surface, causing fever or irritability and thirst while the scabs do not fall, Liangxue Yangying Jian (Cool Blood and Nourish Ying Decoction) or Jiedu Fangfeng Tang (Detoxify and Saposhnikovia Decoction) should be used酌情ly. If the heat is severe, Dalianqiao Yin (Large Forsythia Drink) added with Digupi (Dogwood Root Bark) should be used. Externally, Talcum (Huashi) powder mixed evenly with honey can be applied; sweeping it onto the scabs with a chicken feather will cause them to fall off.

3. If pockmarks protrude and itch incessantly, this indicates that heat toxins are not yet exhausted. Jiedu Fangfeng Tang (Detoxify and Saposhnikovia Decoction) should be used as the main treatment.

4. If pockmarks itch, and after peeling off the scabs there is bleeding or subsequent suppuration resembling sores or scabies, this is due to blood heat combined with Qi deficiency. Sijunzi Tang (Four Gentlemen Decoction) or Siwu Tang (Four Substances Decoction) added with Honghua (Safflower), Zicao (Arnebia Root), and Niubangzi (Burdock Fruit) should be used for treatment.

5. If the recovery phase (shouye) is delayed and scabs do not fall, accompanied by drowsiness and desire to sleep, this indicates that pathogenic factors have receded, Zhengqi (Upright Qi) has not yet recovered, and the Spleen and Stomach are weak. Wufu Yin (Five Blessings Drink) or Tianyuan Tang (Origin-Regulating Decoction) should be used for gradual regulation and treatment. If residual fire is not cleared, Suanzaoren Tang (Zizyphus Seed Decoction) is appropriate.

6. After scabs have fallen, sudden deficiency of Middle Qi often results in an inability to eat. Wuyi Yigong San (Five-Ingredient Extra-Effort Powder) or Yangzhong Jian (Nourish Middle Decoction) should be used to regulate.

7. After the recovery phase and scab shedding, if residual heat does not subside and delirium or lethargy occurs, Chen Sha Liu Yi San (Cinnabar Six-to-One Powder) should be taken with Xiaochaihu Tang (Minor Bupleurum Decoction). If constipation and abdominal distension occur, Danggui Wan (Angelica Pill) should be used to promote bowel movement. For severe heat, Dalianqiao Yin (Large Forsythia Drink) is most excellent.

8. If original pustules did not fill with pus and remained dry like bean shells, resulting in white scars even after scab shedding, or if residual heat persists, death may occur even after one day. Immediate supplementation with Bazhen Tang (Eight-Treasure Decoction) or Shiquan Daybu Tang (Ten Complete Great Tonifying Decoction) is required. If toxins are abundant, Xiaodu Yin (Detoxify Poison Drink) must be used first.

9. After scabs have fallen and blood and Qi have not yet recovered, careful nursing and regulation are extremely important. One must strictly avoid bathing, consuming raw or cold foods/drinks, extreme hunger, or overeating, to prevent damage to Zang-Fu Qi and the onset of other diseases that could become lifelong afflictions. Be cautious, be cautious!