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After the smallpox rash has emerged for eight or nine days, if the pustules are full of pus and have a grayish-yellow color, and there are no other symptoms, medication may be omitted. If the rash is dense but the pus is not sufficiently filled, and at this time dietary intake is significantly reduced with excessive phlegm, use Yangwei Kaitan Decoction (Stomach-Nourishing and Phlegm-Resolving Decoction). For thirst, remove Banxia (Pinellia Rhizome) and add Maidong (Ophiopogon Tuber) 8 fen, Beiweizi (Schisandra Berry) 9 grains. For vomiting and reflux, add Huoxiang (Patchouli Herb) and Sharen (Amomum Fruit) 3 fen. During the stage of pus formation, avoid using Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), and Banxia (Pinellia Rhizome), lest they dry up the essence fluids and hinder the flow of pus. When approaching the scabbing stage, these herbs may then be used.

At this time, if there is hiccups (e ni), commonly known as "e," which indicates stomach qi rebelling upward, take Zhen Huangtu (True Yellow Earth) and smell it near the nose to stop it immediately. At this stage, when the pustules are full, they may sometimes be affected by cold. Suddenly, all pustules turn purple-black, resembling the color of "Zi Bu Wen." There is no need for panic; urgently grind or decoct high-quality Rougui (Cinnamon Bark) in water and administer it for immediate effect. If the patient previously experienced chills and teeth grinding, this is due to true qi emerging externally while internal deficiency-cold exists; Jianzhong Tang (Middle-Building Decoction) is appropriate, stopping the symptoms after one dose. Severe cases may require no more than two doses. Chills and teeth grinding occurring after the scabbing phase should be treated similarly. Some argue that chills and teeth grinding can be either heat or cold patterns: if the rash is red-purple, erupts simultaneously, accompanied by fever, restlessness, thirst, constipation, dark scanty urine, and a surging-rapid pulse, it is a heat pattern. This is because stomach heat causes teeth grinding, and lung heat causes chills. If the rash is pale white, with thin skin and depressed centers, cool body temperature, aversion to cold, normal bowel and bladder movements, and a deep-slow pulse, it is a cold pattern. This is because stomach cold causes teeth grinding, and lung cold causes chills. This explanation is correct. However, nine out of ten such cases belong to cold, and only one out of ten to heat. Before the seventh or eighth day, heat patterns may still appear, but after the seventh or eighth day, heat patterns become rare; hence, no specific formula is provided for heat patterns.

Within ninety days, if the pustules are full and grayish-yellow, accompanied by steaming fever, this indicates the "returning water" phase (absorption and transformation of pus). True yang facilitates metabolism, causing the fluid to dissipate naturally. Those with insufficient yuan qi cannot complete this process on time, resulting in failure to scab when expected; this is a deficiency-cold syndrome. Symptoms include a cool body and cold extremities. One must greatly tonify qi and blood to assist consolidation, using Wenbiao Tiaozhong Decoction (Warm Exterior and Regulate Middle Decoction) as the primary treatment.

If there is steaming fever yet failure to scab when expected, it indicates unresolved toxic vapors. Clearing the heat will allow the rash to resolve naturally. Use Qingbiao Sandu Decoction (Clear Exterior and Disperse Toxicity Decoction), or mix half a wine cup of sugar with boiling water to make one bowl, drink warm. This is called Ganlu Huitian Yin (Sweet Dew Heaven-Returning Drink), which can reduce heat and promote scabbing. However, in cases of severe toxicity, efficacy may be limited.

During scabbing, if external ulceration occurs with continuous dripping of pus, it is called "Shui Ye" (Water Scab). Apply a paste of Xin Wa Fen (New Tile Powder) mixed with duck egg white to the area for immediate drying and shedding.

When scabbing begins, sudden abdominal pain localized at Zhongwan (CV12) indicates stagnation of heat-toxin and blood stasis causing pain. Use Xiaodu Sanxue Decoction (Detoxify and Dispel Blood Stasis Decoction). If the scabs are thick and solid without other symptoms, medication is unnecessary.

After scabbing, if fever or irritability/thirst occurs, differentiate between cold, heat, deficiency, and excess to treat. High fever with heat in the chest, abdomen, hands, feet, head, and face, constipation, and dark scanty urine indicates abundant residual toxin. Immediate detoxification is required; delay may lead to carbuncles after scab shedding. Urgently use Da Lianqiao Yin (Large Forsythia Decoction). If constipation persists, add Shu Jun (Prepared Rhubarb) 5 fen.

If fever is slightly milder, with heat in the head but not the face, heat in the palms and soles but not the backs of hands and feet, mental fatigue, and normal bowel/bladder movements, it is deficiency heat. Use Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). For thirst, add Maidong (Ophiopogon Tuber) 1 qian and Wuweizi (Schisandra Berry) 9 grains.

After scab shedding and restoration, or halfway through shedding, sudden generalized high fever suggests residual toxin attempting to manifest as carbuncles. More severe heat in the limbs, head, chest, or back indicates the location of the carbuncle. This often occurs when pus was insufficient and scabs were thin, falling quickly. Urgently use Da Lianqiao Yin to reduce heat. For constipation, add Jiu Chao Dahuang (Wine-fried Rhubarb) to induce mild purgation. If fever persists, continue administration until heat subsides and the body cools, allowing internal resolution.

Sudden severe headache at the vertex indicates residual toxin attacking upward, possibly due to excessive consumption of hot medicines. Without urgent treatment, the toxin may invade the eyes, causing severe eye disease. Use Da Lianqiao Yin, removing Mutong (Akebia Stem), Cheqiancao (Plantago Seed), and Huashi (Talcum), and add Shengma (Cimicifuga Rhizome), Jiegeng (Platycodon Root) 6 fen, Chuanxiong (Ligusticum Rhizome), and Bohe (Mint Leaf) 4 fen. Administer several doses to disperse the upward-attacking toxin and prevent eye complications.

After scab shedding, mental fatigue, reduced appetite, heat in the chest, abdomen, head, neck, palms, and soles with irritability and thirst indicate internal deficiency. Continue using Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). Even without fever, lethargy, desire to lie down, anorexia, cold extremities, dry mouth/thirst, or pale non-red scars indicate internal deficiency. Also treat with Buzhong Yiqi Tang. Otherwise, further complications may arise.

Note that patients with extensive eruptions have depleted the true qi of the five zang organs and severely exhausted their blood and qi during consolidation and recovery. Although residual toxin may remain, the true qi is extremely deficient. Therefore, when using cooling herbs for detoxification, they must be processed with wine. For weak constitutions, occasionally add Renshen (Ginseng Root), [missing character, likely Huangqi], Danggui (Angelica Sinensis Root), and Shaoyao (Peony Root) to rescue blood and qi. Do not blindly administer raw Sanhuang (Three Yellows: Rhubarb, Coptis, Scutellaria), raw Zhizi (Gardenia Fruit), Dahuang (Rhubarb), or Shigao (Gypsum) simply because heat symptoms exist. At this stage, with weak righteous qi, harsh cold-cooling attacks often result in death after a single dose; this must be strictly avoided!

Those treating smallpox must be cautious at both the beginning and the end. There are two main dangers: excessive toxicity and physical weakness. Death within three to five days before eruption is due to excessive toxicity. Death after scabbing and recovery due to erroneous medication or diet is due to physical weakness. For excessive toxicity hindering eruption, guide the pathogen outward by following its momentum rather than obstructing it with indiscriminate detoxifying herbs, preventing death. Previous discussions warned against this to protect those careful at the start. For weakness, observe the deficiency and tonify, avoiding harsh attacks to ensure safety. Neglecting caution during the consolidation and recovery phases often leads to errors. Thus, this serves as a warning for those careful at the end.