顺证结痂次序脱，瘢痕润满色红活，额膝迟落不足虑，阴阳相济自然和。
【注】结痂顺证，谓痘结痂根据次序而脱落也。瘢痕润满者，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。若周身之痂落尽，而额膝迟落者，不足虑也。盖
头额为孤阳，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 。
【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。已上二证，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 者，谓其毒留久，必发痘毒火疮也。
逆证结痂痂不脱，痂脱痕色白不红，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，谓痘痕干枯黑黯，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。
痂浓光泽如栗色，痂落瘢红润满平，干燥不落血分热，周痂浸淫湿所乘。半掀半连
肌表热，瘢紫黑焦毒未清，色赤凸起为风热，色白凹陷是虚形。
【注】痂浓光润如栗色者，谓结痂浓而不薄，不干不湿，不黑不白，如栗壳色。痂落
瘢红泽满平者，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，乃毒未清也。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，丹红翘芷连甘桔。
【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） 桔梗
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，甚则周身溃烂，小水短涩，大便溏泄，此湿
胜浸淫之故也。宜用五苓散分利之，湿除而痴自落矣。
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
半掀半连在表热，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，解毒芩连栀子柏，加丹生地草金翘。
【注】痘当落痴之后，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，毒瓦斯未尽化故也。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 黄柏 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，瘢凸不平，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
落痂凹陷最可虞，色白形羸气血虚，大补参苓白术草，归芎芍地桂黄 。
【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（土炒） 甘草（炙） 当归 川芎 白芍（炒） 熟地黄
肉桂 黄 （蜜炙）
引加煨姜，水煎服。
The scabs of the favorable pattern fall off in sequence; the scars are moist, full, and bright red. Delayed falling of scabs on the forehead and knees is not a cause for concern; when Yin and Yang harmonize naturally, recovery occurs.
[Note] The favorable pattern of scabbing refers to the smallpox scabs falling off according to their natural order. "Moist and full" means the scars are moist rather than dry, and full rather than depressed. "Bright red" means the scars are not hyperemic but have a vibrant red color. If the scabs on the rest of the body have fallen completely, but those on the forehead and knees remain delayed, this is not a matter for worry. This is because the forehead represents isolated Yang, and the feet and knees represent isolated Yin; only when Yin and Yang complement each other will the scabs fall naturally.
The scabs of the dangerous pattern do not fall off completely; the scars are dry with little vibrancy. Residual toxins often leave scars that are purple and dark; after smallpox, fire sores (huoyang) must develop.
[Note] The dangerous pattern of scabbing refers to the incomplete shedding of smallpox scabs. "Dry scars" means the scars lack moisture and luster. Although these two patterns belong to the dangerous category, if the patient's diet is robust and appetizing, and urination and defecation are harmonious, even danger is not a cause for concern. "Residual toxin" refers to the unresolved pathogenic factors remaining after smallpox. A purple-dark color indicates that heat from residual toxins remains in the Blood level. "Sores" refer to toxic fire blisters caused by long-standing toxins.
The scabs of the unfavorable pattern do not fall off; if they do fall, the scars are white and not red. The smallpox base appears shiny purple or withered and dark; how can life be sustained when Qi is deficient and the physique is emaciated?
[Note] The unfavorable pattern of scabbing refers to smallpox scabs failing to fall off after a long period. If the scabs have fallen but the scars are purely white without redness, this indicates severe deficiency due to blood loss. "Shiny purple smallpox base" means the scars float with a shiny purple color, indicating external blazing of toxic flames. "Withered and dark" means the scars are dry, black, and dull, indicating toxins binding the blood leading to death. "Qi deficiency and emaciated physique" means that after the smallpox scabs fall, the child's Yuan Qi is deficient and weak, making it difficult to support the body; upon what can life depend?
Scabs thick and glossy like chestnut color; after falling, scars are red, moist, full, and flat. Dryness and failure to fall indicate Heat in the Blood level; oozing around the scabs indicates invasion by Dampness. Half-lifted and half-attached indicates Heat at the Muscle-Biome level; purple-black scorched scars indicate Unclear Toxins; red and protruding indicate Wind-Heat; white and depressed indicate Deficiency patterns.
[Note] Scabs thick and glossy like chestnut color means the scabs are thick rather than thin, neither dry nor wet, neither black nor white, resembling the color of a chestnut shell. After scabs fall, scars being red, moist, full, and flat—neither protruding nor depressed—indicates a favorable pattern of smallpox scabbing and shedding. Dry scabs that do not fall indicate Heat in the Blood level. Oozing around the scabs indicates Dampness pathogens. Half-lifted and half-attached indicates Heat at the Muscle-Biome level. Purple-black scorched scars indicate Unclear Toxins. Red and protruding scars indicate Excess Wind-Heat. White and depressed scars indicate Qi and Blood Deficiency. Practitioners must distinguish these carefully.
Liangxue Jiedu Tang (Cool Blood and Resolve Toxin Decoction)
Scabs are dry and unmoistened; difficulty in falling indicates Heat in the Blood level. Cool blood and resolve toxins using Danggui, Shengdihuang, Zicao, Danpi, Honghua, Lianqiao, Baizhi, Chuan Huanglian, Gancao, and Jiegeng.
[Note] After smallpox reaches the scabbing stage, if scabs fail to fall as expected, presenting with dryness and lack of moisture, bright red roots, thirst for cold drinks, and irritability, this is due to toxic heat stagnating in the Blood level. Liangxue Jiedu Tang should be used primarily; once the heat clears, the scabs will fall naturally.
Liangxue Jiedu Tang (Cool Blood and Resolve Toxin Decoction)
Danggui (Angelicae Sinensis Radix), Shengdihuang (Rehmanniae Radix), Zicao (Arnebiae Radix seu Rhizoma), Danpi (Moutan Cortex), Honghua (Carthami Flos), Lianqiao (Forsythiae Fructus, heart removed), Baizhi (Angelicae Dahuricae Radix), Chuan Huanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Jiegeng (Platycodonis Radix).
Add Dengxin (Junci Medulla) as a guide; decoct in water and take orally.
Wuling San (Five-Ingredient Powder with Poria)
After scabbing, fluid leaks from the base; severe cases involve ulceration due to Dampness injury. Wuling San contains Zhuling, Zexie, Rougui, Fuling, and Baizhu.
[Note] When smallpox has formed scabs but not yet fallen, if fluid leaks from the base, or even if the whole body ulcerates, accompanied by scanty and difficult urination and loose stools, this is due to excessive Dampness invading. Wuling San should be used to separate and drain; once Dampness is removed, the scabs will fall naturally.
Wuling San (Five-Ingredient Powder with Poria)
Zhuling (Polypori Porri Sclerotium), Zexie (Alismatis Rhizoma), Rougui (Cinnamomi Cortex), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried).
Add Dengxin (Junci Medulla) as a guide; decoct in water and take orally.
Jingfang Jiedu Tang (Schizonepeta and Saposhnikovia Decoction to Resolve Toxins)
Half-lifted and half-attached indicates Heat at the Exterior; lingering tendency to fall but not fully. Jingfang Jiedu Tang uses Jingjie, Fangfeng, Chishao, Dihuang, Gancao, Jinyinhua, Mutong, Jiegeng, Digupi, and Lianqiao.
[Note] After smallpox scabs should fall, if they fail to do so, with half lifted and half tightly adherent, presenting with body heat, dryness, and red skin, this indicates Heat at the Muscle-Biome level. Jingfang Jiedu Tang should be used primarily.
Jingfang Jiedu Tang (Schizonepeta and Saposhnikovia Decoction to Resolve Toxins)
Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Chishao (Paeoniae Radix Rubra), Shengdihuang (Rehmanniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Jinyinhua (Lonicerae Japonicae Flos), Mutong (Akebiae Caulis), Jiegeng (Platycodonis Radix), Digupi (Corni Cortex), Lianqiao (Forsythiae Fructus, heart removed).
Add Shengjiang (Zingiberis Rhizoma Recens) as a guide; decoct in water and take orally.
Huanglian Jiedu Tang Modified (Coptis Decoction to Resolve Toxins with Additions)
After scabs fall, scars are purple, black, or scorched; toxic heat stagnation has not dissipated. Resolve toxins with Huangqin, Huanglian, Zhizi, and Huangbai; add Danpi, Shengdihuang, Gancao, Jinyinhua, and Lianqiao.
[Note] After smallpox scabs fall, if scars are purple, scorched, or black, presenting with high fever throughout the body, irritability, and thirst, this is due to insufficient nourishment during the blistering stage and incomplete transformation of toxic vapors. Huanglian Jiedu Tang modified with Shengdihuang, Lianqiao, Danpi, Jinyinhua, and Gancao should be used.
Huanglian Jiedu Tang Modified (Coptis Decoction to Resolve Toxins with Additions)
Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), Huangbai (Phellodendri Cortex), Danpi (Moutan Cortex), Shengdihuang (Rehmanniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Jinyinhua (Lonicerae Japonicae Flos), Lianqiao (Forsythiae Fructus, heart removed).
Add Dengxin (Junci Medulla) as a guide; decoct in water and take orally.
Jiedu Fangfeng Tang (Decoction to Resolve Toxins and Dispel Wind)
After falling, scars are red and swollen; internal heat unresolved compounded by external Wind. Resolve toxins with Huangqin, Shengdihuang, and Gancao; add Lianqiao, Niubangzi, Jingjie, Fangfeng, Jinyinhua, Chishao, and Shengma.
[Note] After smallpox scabs fall, if scars are uneven, red, and bright, or accompanied by fever or itching, this is due to excess Heat in the Blood combined with external Wind invasion. Jiedu Fangfeng Tang should be used primarily.
Jiedu Fangfeng Tang (Decoction to Resolve Toxins and Dispel Wind)
Huangqin (Scutellariae Radix), Shengdihuang (Rehmanniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Lianqiao (Forsythiae Fructus, heart removed), Niubangzi (Arctii Fructus, fried and ground), Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Jinyinhua (Lonicerae Japonicae Flos), Chishao (Paeoniae Radix Rubra), Shengma ( Cimicifugae Rhizoma).
Add Shengjiang (Zingiberis Rhizoma Recens) as a guide; decoct in water and take orally.
Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction)
Depressed scars after falling are most alarming; white color and emaciated physique indicate Qi and Blood Deficiency. Great tonification uses Renshen, Fuling, Baizhu, and Gancao; plus Danggui, Chuanxiong, Baishao, Shudihuang, Rougui, and Huangqi.
[Note] After smallpox scabs fall, if scars are depressed and do not rise, appearing white and non-red, presenting with mental fatigue, weakness, poor appetite, and low food intake, this indicates a pattern of dual deficiency of Qi and Blood. Shiquan Dabu Tang should be used primarily.
Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction)
Renshen (Ginseng Radix), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried), Gancao (Glycyrrhizae Radix et Rhizoma, honey-roasted), Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba, fried), Shudihuang (Rehmanniae Radix Preparata), Rougui (Cinnamomi Cortex), Huangqi (Astragali Radix, honey-roasted).
Add Weijiang (Zingiberis Rhizoma Preparatum) as a guide; decoct in water and take orally.