十朝浆足应收靥，先蜡后栗似螺形，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，后如栗壳之色，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痴，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。
险证浆足色不苍，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。已上诸证，皆收靥险证。若二便调和，饮食强美，则险化为顺，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， 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，此属不足难敛也。 赤溃臭，此
属毒盛敛也。浆水浸渍。此属湿盛难敛也。靥速窠燥，此属火盛难敛早也。治者须详辨之。
回浆饮
皮嫩浆清收敛迟，此证当从不足医，回浆参苓白术草，首乌白芍炙黄 。
【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 （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
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 肿而赤，溃烂而臭，通身大热，烦
渴不宁，此毒瓦斯太盛之故也。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。其现证轻则有孔漏浆；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 赤苓 猪苓 泽泻 白术（土炒） 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，更现证周身窠粒干燥，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, crusting (scabbing) should begin. The scabs first appear waxy yellow, then take on the color of chestnut shells, resembling a spiral shape. The process of forming scabs proceeds neither too fast nor too slow, occurring in order; with moist scabs and a harmonious body, this indicates a favorable course (Shun Zheng).
[Note] "Full fluid on the tenth day" refers to the period when crusting is expected. However, the scabs must first resemble waxy yellow, then the color of chestnut shells, rising like a spiral shell; this represents an auspicious outcome for smallpox/rash. "Neither too fast nor too slow" means that those with darker, older-looking lesions crust first, followed by those slightly less mature, proceeding from top to bottom in sequence. Furthermore, if the scabs are lustrous and moist, and the body is free of disease, this is undoubtedly a favorable course.
In dangerous courses (Xian Zheng), although the fluid is sufficient, the color is not dark/old; the fluid stagnates without crusting, or the lesions ulcerate or are damaged. If the scabs are purple-black and do not shed immediately, but bowel movements are regular and appetite is good, there is no need for panic.
[Note] Dangerous courses during crusting refer to cases where fluid is sufficient but the color lacks maturity. "Stagnant fluid without crusting" means the fluid fails to crust after the appropriate time. "Ulceration" refers to the breaking down of pustules. "Damage" refers to injury caused by scratching due to itching. Purple-black scabs indicate the scabs are purple-black; "not shedding immediately" means the scabs form but do not fall off promptly. All the above conditions belong to dangerous courses during crusting. If urination and defecation are harmonious, and diet is robust and delicious, the dangerous course transforms into a favorable one, requiring no alarm.
Failure to crust accompanied by external peeling constitutes a reverse course (Ni Zheng - adverse/unfavorable progression). Scabs thin as bran, dark/black and dull, or pale white are ominous signs. Adhesion of scabs preventing detachment, or even if detached, appearing dry and withered, indicates a fatal prognosis.
[Note] "Failure to crust with external peeling" means the skin peels off before proper crusting occurs; this is called inverted crusting (Dao Ye) and constitutes a reverse course. Thin, dark, and black scabs mean the scabs are thin like bran and black like coal; pale white means the scabs are pale white and lack luster; thus, all are ominous. Adhesion preventing detachment means pus causes prolonged adhesion. Even if detached, dryness and withering means the scabs fall off but remain dry and unmoistened. Both these scenarios indicate a fatal prognosis.
When fluid is sufficient, color is mature/dark, and the apex of the lesion is slightly scorched, gradual crusting requires no treatment. Crusting that is too late or too early is not auspicious; one must differentiate whether it stems from deficiency-toxicity or damp-heat. Clear fluid and tender skin indicate a deficiency pattern; redness, ulceration, and foul odor indicate toxic heat confusion; fluid soaking indicates excessive dampness; rapid crusting with dry fossae indicates fire scorching.
[Note] When fluid reaches sufficiency, the color is mature, the lesion apex is slightly scorched, and crusting proceeds sequentially, these are all favorable courses for crusting, requiring no treatment. "Too late" means failing to crust when one should. "Too early" means crusting when one should not. Neither is auspicious, but the underlying cause must be differentiated: either deficiency, excess toxicity, damp-fluid retention, or excess fire. Treatment must follow the specific syndrome. For example, clear fluid and tender skin indicate deficiency making consolidation difficult. Redness, ulceration, and foul odor indicate excess toxicity making consolidation difficult. Fluid soaking indicates excess dampness making consolidation difficult. Rapid crusting with dry fossae indicates excess fire making premature consolidation difficult. Practitioners must distinguish these carefully.
Hui Jiang Yin (Return Fluid Decoction)
Tender skin, clear fluid, and delayed consolidation require treatment addressing deficiency. Use Hui Jiang Yin (Renshen, Fuling, Baizhu, Gancao, Heshouwu, Baishao, Zhi Huangqi).
[Note] At the stage of consolidation, if crusting fails to occur, skin is tender, fluid is thin, and symptoms include cool body temperature, cold extremities, and loose stools, this is a deficiency syndrome due to insufficient Yuan Qi (Original Qi). It is suitable to use Hui Jiang Yin to tonify and assist consolidation.
Hui Jiang Yin (Return Fluid Decoction)
Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix, honey-fried), Bai Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma, soil-fried), He Shouwu (Polygoni Multiflori Radix, processed), Baishao (Paeoniae Radix Alba, stir-fried), Gancao (Licorice Root, honey-fried).
Decoct with Wei Jiang (Baked Ginger) as an adjunct, taken orally.
Da Liao Qiao Yin (Large Forsythia Decoction)
Redness, ulceration, and foul odor due to excess toxicity can be cleared of various heats using Da Liao Qiao Yin. Ingredients include Chaihu, Huangqin, Danggui, Baishao, Cheqianzi, Zhizi, Gancao, Liaoqiao, Niubangzi, Jingjie, Fangfeng, Chantui, Huashi, Mutong.
[Note] During the crusting stage, some cases fail to consolidate due to excess toxicity. Symptoms may include swollen, red lesions, ulceration with foul odor, generalized high fever, restlessness, thirst, and agitation. This is due to excessive toxic vapors. Da Liao Qiao Yin should be used to resolve this.
Da Liao Qiao Yin (Large Forsythia Decoction)
Liaoqiao (Forsythiae Fructus, heart removed), Fangfeng (Saposhnikoviae Radix), Niubangzi (Arctii Fructus, stir-fried and crushed), Jingjie (Schizonepetae Spica), Huangqin (Scutellariae Radix), Danggui (Angelicae Sinensis Radix), Chantui (Cicadae Periostracum), Chaihu (Bupleuri Radix), Huashi (Talcum), Zhizi (Gardeniae Fructus), Chi Shao (Paeoniae Radix Rubra), Cheqianzi (Plantaginis Semen), Mutong (Akebiae Caulis), Gancao (Licorice Root, raw).
Add Dengxincao (Junci Medullae) as an adjunct, decoct in water, and take orally.
Chu Shi Tang (Dampness-Removing Decoction)
Generalized soaking with oozing fluid indicates damp-fluid affecting the Spleen. Chu Shi Tang contains Chi Ling, Zhuling, Mutong, Zexie, Hougui, Cangzhu, Fangfeng, Baizhu, and Qianghuo.
[Note] During the crusting stage, some cases fail to consolidate due to excess dampness. Mild cases show leaking fluid from pores; severe cases show generalized ulceration, abdominal distension, and short urination. These are caused by damp-fluid pathogenic factors. Chu Shi Tang should be used to promote diuresis and remove dampness; once dampness is eliminated, the rash will naturally crust.
Chu Shi Tang (Dampness-Removing Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Cangzhu (Atractylodis Rhizoma, soaked in rice wash water and stir-fried), Fangfeng (Saposhnikoviae Radix), Chi Ling (Poria cum Rosa), Zhuling (Polypori Umbilicati Mycelium), Zexie (Alismatis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, soil-fried), Mutong (Akebiae Caulis), Hougui (Cinnamomi Cortex, thin).
Add Shengjiang (Fresh Ginger) and Dengxincao (Junci Medullae) as adjuncts, decoct in water, and take orally.
Qing Du San (Toxin-Clearing Powder)
Rapid crusting is often due to fire injury. Generalized dryness of the lesion fossae is abnormal. Qing Du San contains Danggui, Baishao, Liaoqiao, Danpi, Gancao, Liaoqiao, Niubangzi, Mutong, Huaisheng, and Shengdi.
[Note] When the rash should not be crusting, sudden crusting occurs. Symptoms include generalized dryness of the lesion fossae, thirst, fever, and restlessness/agitation. This is due to congested and excessive toxic fire. Qing Du San is indicated.
Qing Du San (Toxin-Clearing Powder)
Shengdi (Rehmanniae Radix Preparata), Chi Shao (Paeoniae Radix Rubra), Liaoqiao (Forsythiae Fructus, heart removed), Jinyinhua (Lonicerae Japonicae Flos), Niubangzi (Arctii Fructus, stir-fried and crushed), Mutong (Akebiae Caulis), Huanglian (Coptidis Rhizoma), Danggui (Angelicae Sinensis Radix), Danpi (Moutan Cortex), Gancao (Licorice Root, raw).
Decoct in water and take orally.