痘至落痂。一大义工案了手矣子尚有言否曰是何言也。末路难恃。功亏一篑。正此之谓
也。如
痂久不脱。或堆如鸡屎。薄如竹膜泡发丹缠。痈肿疔溃或疹。或麻。或呕吐作渴。或赤白痢
。或咳嗽。或虚烦不眠。坐立微颤。唇不盖齿。咽哑腹痛。或热或发痒。而形色粉红非险乎
。又如破而不贯。坑陷干枯。惊搐无魂。走马牙疳目暗吊白或胸高而喘。战掉不休。疤痕之
色皆粉自不红非逆乎。且气血初定。相火易煽。即靥后疤红。而不禁辛热。犹致目疾。不避
风寒。犹发疮痍。不节饮食。犹成吐痢诸症。子何以无事目之。
靥渐结渐落。色明而浓顺也或粘肉不脱。或嵌入肉中。或半粘半揭。或痂半有衣。或薄
如竹膜。色煤黑者。险也。有虚实寒热。实而热者。连翘饮主之。虚而寒者。方内加参 。肉桂
治之。治廨色亦然。紫红者实也。粉红者虚也。粉白者气血衰也。气血衰服药不转者死。
痘
内实毒不能留。故寻窍而出。经曰。营气不从。逆于肉里。则生肿是矣。曲池委中。三阴交
会之地。毒多壅此。虚故也。然有实者。有虚者。形体怯弱。食少微热。肿处不痛。虚也。
形体壮盛。身热能食。痛叫不已。实也。虚者流气饮。实者连翘饮。外并以必胜膏贴之溃而
出脓。大补汤。久不收口者。生肌膏涂之。几多痈不食。呕泻不休。睛慢唇白。而脓出清水
者死。靥后病目俗皆谓目中出痘。加果痘也。胡不见报痘成脓。而遂结痂耶。此症亦医之过
也。古云热蕴于肝。则目病。确言也。有赤肿而痛。不能开者。赤肿凉肝散。翳膜凉隔散。
切忌点药。睛突瞳陷。不能治矣。痘初出。而即用护眼法。乌有后患。
丹口疳皆胃热致之。有轻者重者。有死不治者。满口白糜。或红点簇轻症也。灵枣丹吹
之。唇舌肿硬。牙龈黑烂。成疳者重也内服甘露饮。外吹灵枣丹。烂入喉者。亦以药吹之。色如
干酱。臭烂日甚。而鼻发红点者死。俗名走马疳。然此亦医之过也。
痘后腹痛甚重。须分治之。伤食和中丸。余毒连翘饮。血虚本方去翘桔。加参 。干姜
治之。腹痛见舌白者死。元气竭也。
惊发痘后。书云。莫救者。是目闭无魂。更兼吐泻唇白肢冷。如热甚小便闭塞。或素有
惊疾
。又非不可治者。痘后出喑。名曰痧。盖痘落发此吉兆也。不可作寻常痧麻治。只消疏风之
剂。丹与瘾疹亦然。
痘后浮肿。囊大如钵。毒匿皮肤。以连翘饮。加腹皮。茵陈主之。有加枳壳。倍柴胡。
痘疹到了结痂脱落阶段，看似大功告成、万事大吉了。但还要再说几句吗？回答说：这是什么话呢？末路最难依靠，功亏一篑，说的正是这种情况。
如果痂皮久久不脱落，或者堆积得像鸡屎一样，或者薄得像竹膜；水泡发丹缠绕，痈肿疔疮溃烂，或者出疹，或者出麻疹，或者呕吐口渴，或者赤白痢疾，或者咳嗽，或者虚烦失眠，坐立时微微颤抖，嘴唇无法覆盖牙齿，咽喉嘶哑腹痛，或者发热，或者发痒，而颜色粉红，这难道不是险症吗？
又如痘疮破溃后不能贯透，坑陷干枯，惊厥抽搐无神，走马牙疳，眼睛昏暗或吊睛白眼，或者胸部高起而气喘，战栗抖动不停，疤痕的颜色都是粉色而不红润，这难道不是逆症吗？况且气血刚刚安定，相火容易煽动，即使结痂后疤痕发红，如果不忌口辛辣热性食物，仍然会导致眼疾；不避风寒，仍然会引发疮疡；不节制饮食，仍然会形成呕吐、痢疾等各种病症。你怎么能当作没事来看待呢？
结痂逐渐形成并脱落，颜色明亮且浓重，这是顺症。有的粘在肉上不脱落，有的嵌入肉中，有的半粘半揭，有的痂皮半有衣被（指有脓液或分泌物包裹），有的薄如竹膜，颜色黑如煤炭的，是险症。这里有虚实寒热之分。实证而热的，用连翘饮主治；虚证而寒的，在方剂中加入人参、肉桂治疗。治疗廨（此处疑为“靥”之误，指痘痂）颜色的情况也是如此。颜色紫红的是实证，颜色粉红的是虚证，颜色粉白的是气血衰败。气血衰败，服药后没有好转的，就会死亡。
痘内的实毒不能留存体内，所以寻找孔窍排出。经书说：“营气运行不畅，逆乱于肌肉纹理之间，就会产生肿胀。”曲池、委中、三阴交交会的地方，毒素多壅滞于此，这是因为正气虚弱。然而也有实证和虚证的区别。形体怯弱，食少微热，肿胀处不痛的，是虚证；形体壮盛，身热能食，疼痛呼叫不停的，是实证。虚证用流气饮，实证用连翘饮。外用必胜膏贴敷以促使化脓。久不收口的，用大补汤；久不愈合的，涂生肌膏。如果许多痈疮患者不吃东西，呕吐腹泻不止，眼睑下垂嘴唇苍白，流出清水样脓液的，就会死亡。
痘后患眼病，俗人都认为是眼中出了痘子，加上果痘（一种并发症）。怎么没见报痘化成脓后就结痂了呢？这个病症也是医生的过错。古话说：“热蕴积在肝脏，就会导致眼病”，这是确切的言论。如果有红肿疼痛，不能睁眼的，用赤肿凉肝散；有翳膜的，用凉隔散。切忌点药，如果眼球突出瞳孔下陷，就无法治疗了。如果在痘初出时就采用护眼的方法，哪里会有后患呢？
丹口疳都是由胃热引起的。有轻有重，有死不治的。满口白糜，或者有红点簇集的，是轻症。用灵枣丹吹入患处。嘴唇舌头肿胀僵硬，牙龈黑烂，形成疳疮的，是重症。内服甘露饮，外吹灵枣丹。腐烂进入喉部的，也用药物吹入。颜色像干酱，臭味腐烂日益严重，并且鼻子发出红点的，就会死亡。俗名叫走马疳。然而这也是医生的过错。
痘后腹痛非常严重，必须区分治疗。如果是伤食，用和中丸；如果是余毒，用连翘饮；如果是血虚，在本方中去掉连翘、桔梗，加入人参、干姜治疗。腹痛见到舌苔白的，就会死亡，这是元气竭尽的表现。
痘后出现惊风，书上说不可救的，是指眼睛闭合无神，再加上呕吐腹泻、嘴唇苍白、四肢冰冷。如果热势很盛导致小便闭塞，或者素有惊风疾病，又不是不可治疗的。痘后出现声音嘶哑，名叫痧。这其实是痘落之后发出的吉兆，不可以当作寻常的痧麻来治，只需要服用疏风的药剂。丹毒与瘾疹也是如此。
When the smallpox lesions reach the stage of scabbing and falling off, it seems that the great work is accomplished and everything is settled. But should I say more? The response is: What kind of talk is this? The final stage is difficult to rely on; "a job undone by a single basket of earth" (falling short at the last moment) precisely describes this situation.
If the scabs do not fall off for a long time, or pile up like chicken droppings, or are as thin as bamboo membrane; if blisters and red rashes tangle together, carbuncles and sores ulcerate, or rashes appear, or measles erupt, or vomiting and thirst occur, or dysentery with red and white discharge appears, or coughing occurs, or deficiency heat causes irritability and insomnia, sitting or standing with slight trembling, lips unable to cover the teeth, hoarse throat with abdominal pain, fever, or itching, and the color is pinkish-red—is this not a dangerous condition?
Furthermore, if the lesions break but fail to penetrate fully, becoming sunken, dry, and withered; if there are convulsions and loss of spirit; if gangrenous stomatitis (Zouma Yagan, 走马牙疳) occurs, eyes become dim or deviate upward (Diao Bai, 吊白); if the chest is elevated with panting, and tremors ceaseless; if the scar colors are all pinkish without redness—is this not an adverse condition? Moreover, when Qi and Blood have just stabilized, Ministerial Fire (Xiang Huo, 相火) is prone to flare up. Even if the scars turn red after healing, failing to avoid pungent and hot foods will still cause eye diseases; failing to shield against wind and cold will still trigger sores; failing to regulate diet will still lead to vomiting, dysentery, and other syndromes. How can you treat this as if nothing were wrong?
As scabs gradually form and fall off, bright and dense colors indicate a favorable course (Shun, 顺). Some may stick to the flesh without falling off, some may be embedded in the flesh, some half-stuck and half-peeled, some scabs partially covered with exudate, some thin as bamboo membrane, or black as coal—these are dangerous signs. There are distinctions between deficiency/excess and cold/heat. For excess-heat patterns, Lianqiao Yin (Forsythia Decoction) is the primary treatment. For deficiency-cold patterns, Ginseng (Renshen, 人参) and Cinnamon Twig (Rougui, 肉桂) are added to the formula. The same applies to treating the color of the healed lesions. Purple-red indicates excess; pinkish-red indicates deficiency; pinkish-white indicates decline of Qi and Blood. If Qi and Blood are declining and medication fails to improve the condition, death ensues.
The excess toxins within the smallpox cannot remain in the body, so they seek orifices to exit. The Classics state: "When Ying Qi (Nutritive Qi) does not flow smoothly and rebels within the muscle tissue, swelling arises." The area where Quchi (LI11), Weizhong (BL40), and Sanyinjiao (SP6) converge is where toxins often stagnate due to deficiency. However, there are also excess and deficiency cases. Those with weak constitutions, poor appetite, slight fever, and non-painful swelling are deficient. Those with robust constitutions, body heat, good appetite, and incessant painful crying are excessive. Deficient patterns are treated with Liqi Yin (Flowing Qi Decoction); excessive patterns with Lianqiao Yin. Externally, Bisheng Gao (Victory Ointment) is applied to promote suppuration. For wounds that do not close for a long time, Dabu Tang (Great Tonification Decoction) is used; for those that do not heal, Shengji Gao (Tissue Regeneration Ointment) is applied. If many patients with carbuncles refuse food, suffer from continuous vomiting and diarrhea, have ptotic eyelids and pale lips, and secrete clear water-like pus, they will die.
Eye diseases after smallpox are commonly believed by laypeople to be caused by pox appearing in the eyes, compounded by other factors. Why is it not seen that pox suppurates and then forms scabs? This syndrome is also the fault of the physician. Ancient wisdom states: "Heat accumulating in the Liver leads to eye disease," which is accurate. If there is redness, swelling, and pain preventing the eyes from opening, Chizhong Lianggan San (Redness-Swelling Cooling Liver Powder) is used; if nebulae (Yi Mo, 翳膜) are present, Liangge San (Cooling Partition Powder) is used. Eye drops must be strictly avoided; if the eyeball protrudes and the pupil sinks, it is incurable. If eye protection methods were employed when the smallpox first erupted, there would be no subsequent complications.
Dan Kou Gan (Gangrenous Stomatitis of the Mouth) is caused by Stomach Heat. It varies from mild to severe, with some cases being fatal. White plaques covering the entire mouth, or clusters of red spots, indicate mild cases. Lingzao Dan (Spirit Date Pill) is insufflated into the lesion. Swollen and stiff lips and tongue, with black and rotting gums forming gangrene, indicate severe cases. Internally, Ganlu Yin (Sweet Dew Decoction) is taken; externally, Lingzao Dan is insufflated. If the rot extends into the throat, medication is also insufflated. If the color resembles dried sauce, the foul odor and rot worsen daily, and red spots appear on the nose, death occurs. This is commonly known as Zouma Gan (Running Horse Gangrene). However, this is also the fault of the physician.
Severe abdominal pain after smallpox requires differentiated treatment. For food stagnation, Hezhong Wan (Harmonize Middle Pill) is used. For residual toxins, Lianqiao Yin is used. For blood deficiency, the base formula has Forsythia (Lianqiao) and Platycodon (Jiegeng) removed, and Ginseng (Renshen) and Dried Ginger (Ganjiang, 干姜) are added. Abdominal pain accompanied by a white tongue coating indicates death, signifying exhaustion of Yuan Qi (Original Qi).
Convulsions after smallpox: texts state that cases are incurable if the eyes are closed and spiritless, combined with vomiting, diarrhea, pale lips, and cold limbs. If high fever causes urinary obstruction, or if there is a pre-existing history of convulsive disorders, these are not necessarily untreatable. Hoarseness after smallpox is named Sha (Sand/Rash). This is actually an auspicious sign following the shedding of scabs and should not be treated as ordinary Sha or measles; only dispersing-wind formulas are needed. Dan (Erysipelas) and Urticaria (Yin Zhen, 瘾疹) are treated similarly.
Edema after smallpox, with the scrotum enlarged like a bowl, indicates toxins hidden in the skin. Lianqiao Yin is used with Betel Nut Peel (Fupi, 腹皮) and Yinchen (Artemisia Capillaris) as the main treatment. In some cases, Aurantium (Zhike, 枳壳) is added, and Bupleurum (Chaihu, 柴胡) is doubled.