痘至十日。毒解矣。脓亦转黄作苍蜡色。元气实者。痂必循次而结。如口角与阳物先结
。正收也。身渐轻快。肿渐清解眼蒙蒙而欲开。食倍常。便如故。从上至下而收。结痂浓色
红。大事毕矣。不然犹未可以为喜。结痂时。忽忽发热者。蒸浆作靥也。不必虑。
凡一时痂尽。一痂即落者。毒火烁也。急解之。此症必脓未充足。若声哑烦闷。喘促不
食。死期迫矣。否则必发痈毒而解。
痘至十日。正收靥之期。靥而不靥。非气虚。必血热也。气虚方内加参 。丁柱治之。
血热方内加
芩连。解毒治之气虚血热唇舌红不红辨之也。亦有时令致然者。时之寒也。用温剂以敛之。
时之热也。用凉剂以清之。
凡不及期眼开者重。轻症不拘。又过期眼不开者亦重。十二日眼开期矣。
当结靥时。渴饮无休。津液竭矣。方内加生脉散主之。若渴甚而下泻。尤重者。为难治
。凡治渴。切勿利小便。便愈利而渴愈甚矣。
十日九日。半痂半不痂。作泻者。不必虑。乃阳气内回。非贯脓时比也。方内倍白术
。茯苓治之。切忌涩剂。倘不知误用。后必不食而作痢。
十二十三日。有形如火烧烟熏者。生死最决。若音不清。食不入。破处干枯。烦乱不寐
。死症也。音清能食。睡卧安宁。爬破淋漓。神舒气爽。生症也。又当分虚实治。唇舌洁净。温
补兼清解之。唇燥舌苔。单解之。解而苔去。继以平和则攻补两尽矣。
凡当靥时而流浆不已。为过表故也。然亦有饮水霪湿。致然者。两者皆方内倍白术。茯
苓。
。空处复出一层。治功也。俗呼曰翻空痘逆症有此。大吉也。靥后腮红。唇干。面色带紫者
。肺痈将作也。连翘饮治之。桔梗。知母。百合。麦冬宜常服。
痘至结靥未及结痂时必定作气息者第腥臭者佳尸臭者死。全无气息知有余毒也。须解之
额与足迟靥者。独阴独阳也。额与足先靥者重反阴背阳也。当靥之时。凡见腹胀。气喘
。咽
皆死症也。间有一二不死。亦幸活耳。
痘疹发展至第十天，毒邪已解。脓液转为黄色，呈现苍蜡色。元气充实的患者，痂皮必然按顺序结落，如口角和生殖器部位先结痂，这是正常的收敛过程。身体逐渐轻松爽快，肿胀逐渐消退，眼睛朦胧欲开，食欲加倍于平时，大便恢复正常。从上至下依次收敛，结痂颜色浓红，大事便完成了。如果不是这样，还不能算作值得欢喜的事。在结痂时，如果忽忽发热，那是蒸化脓浆形成痂皮的过程，不必担忧。
凡是同时全部结痂、一个痂皮刚脱落另一个就脱落的，是毒火炽盛的表现，急需解毒治疗。这种病症必定脓液未充足。如果出现声音嘶哑、烦闷、气喘急促、不能进食，死期迫近。否则，必定会发出痈毒而痊愈。
痘疹至第十天，正是收靥（结痂）的时期。结痂而不结痂，不是气虚，就是血热。气虚则在方剂中加入人参；丁柱（医家名）治疗此症。血热则在方剂中加入黄芩、黄连以解毒治疗。气虚与血热可以通过观察嘴唇和舌头是否红润来辨别。也有因时令气候导致的情况：气候寒冷，用温性药剂来收敛；气候炎热，用凉性药剂来清解。
凡是不到时间眼睛就睁开的病情重，轻症不拘泥于此。又或过了时间眼睛仍不睁开，病情也重。第十二天是眼睛应睁开的期限。
当结痂时，口渴饮水不止，说明津液枯竭，方剂中加入生脉散主治。如果口渴严重且伴有腹泻，尤其严重，属于难治之症。凡治疗口渴，切勿使用利小便的药物，越利小便，口渴越严重。
第九日或第十日，半结痂半不结痂，出现腹泻的，不必担忧，这是阳气内回，不同于贯脓时期的情况。方剂中加倍使用白术、茯苓治疗。切忌使用涩肠止泻的药物，倘若不知晓而误用，日后必定不能进食并发生痢疾。
第十日至第十三日，痘形如有火烧烟熏痕迹的，生死最为确定。如果声音不清脆、不能进食、破溃处干枯、烦躁混乱无法入睡，是死症。如果声音清脆、能进食、睡卧安宁，抓破后流脓淋漓，精神舒适、气息清爽，是生症。此时应当分辨虚实进行治疗：嘴唇舌头洁净的，用温补兼清解的方法；嘴唇干燥、舌苔厚的，单独使用清解法。清解后舌苔退去，继之以平和之剂，则攻邪与补正两全了。
凡是在结痂时流脓水不止，是因为发汗过度（过表）的缘故。但也有因饮水过多导致湿气停滞，从而引起这种情况的。这两种情况都在方剂中加倍使用白术、茯苓。空白的地方重新长出一层痘，是治疗的功效。俗称为“翻空痘”，逆症中有此表现，是大吉之兆。结痂后腮部发红、嘴唇干燥、面色带紫的，肺痈即将发作，用连翘饮治疗。桔梗、知母、百合、麦冬宜常服。
痘疹至结痂阶段，未到结痂时必定有气味。其中腥臭的是佳兆，尸臭味的是死兆。完全没有气味的，知道是有余毒，必须解毒。额头和脚部迟慢结痂的，属于独阴独阳（阴阳分离之象）。额头和脚部先结痂的，病情重，属于反阴背阳。在结痂的时候，凡是见到腹胀、气喘、咽喉不利等，都是死症。间或有一两个不死，也是侥幸存活罢了。
When the smallpox reaches the tenth day, the pathogenic toxin is resolved. The pus turns yellow and assumes a pale wax color. In patients with substantial Yuan Qi (Primordial Qi), the scabs will form sequentially; for instance, if the corners of the mouth and the genitalia form scabs first, this indicates normal contraction. The body gradually feels light and brisk, swelling subsides, eyes become hazy yet desire to open, appetite doubles as usual, and bowel movements return to normal. Contraction proceeds from top to bottom; when the scabs are thick and red, the major crisis is concluded. If this does not occur, there is no cause for joy yet. During the scabbing process, if sudden fever occurs, it is due to the steaming of pus to form scabs; there is no need to worry.
If all scabs form simultaneously and one falls off only for another to fall immediately, it indicates blazing toxin-fire, requiring urgent detoxification. This condition implies insufficient pus formation. If hoarseness, restlessness, panting, and anorexia appear, death is imminent. Otherwise, carbuncles and sores may erupt, leading to recovery.
The tenth day is the proper time for scabbing (jie ye). Failure to scab indicates either Qi deficiency or Blood heat. For Qi deficiency, add Ren Shen (Ginseng) to the formula; Dr. Ding Zhu treats this condition. For Blood heat, add Huang Qin (Scutellaria Root) and Lian Qiao (for detoxification, though text says Qin Lian, implying Scutellaria and Coptis) to the formula. Qi deficiency versus Blood heat can be distinguished by observing whether the lips and tongue are red. Sometimes, seasonal factors are responsible: if the climate is cold, use warm formulas to consolidate; if hot, use cool formulas to clear.
If the eyes open before the appropriate time, the condition is severe (light cases aside). Conversely, if the eyes do not open after the appropriate time, the condition is also severe. The twelfth day is the deadline for the eyes to open.
During scabbing, if thirst persists without cessation, it indicates exhaustion of Jin Ye (Body Fluids); add Sheng Mai San (Generating the Pulse Powder) to the formula. If severe thirst is accompanied by diarrhea, it is particularly severe and difficult to treat. When treating thirst, never use diuretics; the more you promote urination, the worse the thirst becomes.
On the ninth or tenth day, if half the lesions have scabbed and half have not, accompanied by diarrhea, there is no need to worry. This represents the return of Yang Qi internally, which differs from the pus-filling stage. Increase the dosage of Bai Zhu (Atractylodes Rhizome) and Fu Ling (Poria) in the formula. Strictly avoid astringent herbs; misuse may lead to anorexia and dysentery later.
From the tenth to thirteenth days, lesions resembling burns or smoke stains indicate a definitive prognosis regarding life or death. If the voice is unclear, food cannot be taken, broken areas are dry, and there is restlessness with insomnia, it is a fatal sign. If the voice is clear, food is tolerated, sleep is peaceful, and scratching leads to oozing pus while the spirit is calm and breath is fresh, it is a vital sign. Treatment must distinguish between deficiency and excess: if lips and tongue are clean, use warming tonification combined with clearing and resolving; if lips are dry and tongue has coating, use clearing methods alone. After the coating clears, follow with mild formulas to achieve both expulsion of pathogens and tonification.
If pus flows incessantly during scabbing, it is due to excessive sweating (releasing the exterior). However, it may also result from excessive water intake causing dampness stagnation. In both cases, increase Bai Zhu and Fu Ling in the formula. If new pustules emerge in empty spaces, it is a sign of therapeutic efficacy. Commonly called "Fan Kong Dou" (Reversing Empty Pox), its appearance in adverse conditions is a great auspicious sign. After scabbing, if cheeks are red, lips are dry, and complexion is purplish, Lung Abscess (Fei Yong) is about to develop; treat with Liao Qiao Yin (Forsythia Decoction). Jie Geng (Platycodon Root), Zhi Mu (Anemarrhena Rhizome), Bai He (Lily Bulb), and Mai Dong (Ophiopogon Tuber) should be taken regularly.
At the scabbing stage, before scabs fully form, there is invariably an odor. A fishy smell is auspicious; a corpse-like smell indicates death. No odor at all indicates residual toxins that must be cleared. Delayed scabbing on the forehead and feet indicates separation of Yin and Yang (Du Yin Du Yang). Early scabbing on the forehead and feet indicates severity, representing inverted Yin and Yang. During scabbing, any presentation of abdominal distension, panting, or throat obstruction constitutes a fatal sign. Occasionally, one or two may survive, but only by extreme luck.