（痂，居牙切，疮靥曰痂）
〔海〕 疹脓而不焦，此本治失清凉之气。有如五谷得阳气而成熟，非凉风至则不能实也，天地严肃之气
一加，则万物秀而实矣，与 疹何异？须察何经而清凉之，或下而成严肃之气，则疮气必不至于脓而不
痂矣。要当知之，余毒不尽而疾作，盖出于此。（当是清凉饮子下之是也。）非阳和则苗不秀，非严肃则
秀不实。刘洙疮子诀云∶痘发如脓窠不肯靥者，但调砂糖水与吃。刘提点云∶亦曾试用，但后来结瘢痕白。
〔钱〕五七日痂不焦，是内发热蒸于外，故不得焦痂也，宜宣风散导之，用生犀磨汁解之，必着痂矣。
〔陈〕痘已靥未愈之间，忽被风邪搏之，成疳疮，宜雄黄散、绵茧散治之。又不愈，多渍骨伤筋杀人。
雄黄散 治小儿牙龈生疳蚀疮。
雄黄（一钱） 铜绿（二钱）
上二味，同研极细。每用，量疮大小干贴。
绵茧散 治小儿因痘疮身体及肢节上生疳蚀疮，脓水不绝。
用出蛾绵茧，以生白矾捶碎入茧内令满，炭火烧，令白矾汁尽，取出，研极细。每用，干贴疮口上。
〔钱〕凡痘疮方才着痂，即用菜油不住润之，可揭则揭，若不润及迟揭，疮痂硬即隐成瘢痕矣。
〔陈〕痘痂虽落，其瘢犹黯，或凹凸肉起，当用灭瘢药涂之。
韶粉（一两） 轻粉（一字）
上研细，入炼过猪脂油拌和如膏，涂瘢上。
（痂，读音为居牙切，指疮疡愈合后形成的结痂。）
〔海藏〕痘疹化脓后却不结焦痂，这是因为治疗时失去了清凉之气。这就好比五谷得到阳气才能成熟，如果没有凉风的吹拂，谷物就无法饱满结实；天地间的肃杀清冷之气一旦降临，万物就会秀美且结实，这与痘疹的病情有何不同呢？必须审察是哪一经受邪而给予清凉之法，或者通过泻下法形成肃杀之气，那么疮毒之气就一定不会停留在化脓而不结痂的状态了。应当明白这一点，余毒未尽而疾病复发，往往就是出于这个原因。（这里指的应该是用清凉饮子进行泻下治疗。）没有阳和之气，禾苗就不能抽穗开花；没有肃杀之气，抽穗开花也不能结果结实。刘洙在《疮子诀》中说：痘疮发出后像脓窠一样不肯结痂的，只需调拌砂糖水给患儿服用。刘提点说：也曾试用过这个方法，但后来留下的瘢痕是白色的。
〔钱乙〕痘疹在五到七天后结痂不焦枯，是因为体内发热蒸腾于体表，所以不能形成焦痂，适宜用宣风散来导滞通便，并用生犀角磨汁来清热解毒，这样一定能结痂。
〔陈文中〕痘疹已经结痂但尚未痊愈之间，忽然被风邪侵袭，导致形成疳疮，适宜用雄黄散、绵茧散来治疗。如果仍然不愈，往往会侵蚀骨骼损伤筋脉，甚至导致死亡。
雄黄散 用于治疗小儿牙龈生疳蚀疮。
雄黄（一钱） 铜绿（二钱）
以上两味药，共同研磨成极细粉末。每次使用时，根据疮口的大小，干掺敷贴。
绵茧散 用于治疗小儿因痘疮导致身体及四肢关节上生疳蚀疮，脓水淋漓不绝。
取破茧而出的蚕茧，将生白矾捣碎填入茧内使其填满，用炭火烧灼，直到白矾汁液完全渗出，取出后研磨成极细粉末。每次使用时，干掺敷贴在疮口上。
〔钱乙〕凡是痘疮刚刚结痂，就要用菜籽油不断滋润它，可以揭除时就揭除；如果不滋润且拖延时间揭除，疮痂变硬就会隐蔽地形成瘢痕。
〔陈文中〕痘痂虽然脱落，但瘢痕仍然颜色暗黑，或者凹凸不平、肌肉隆起，应当使用灭瘢药涂抹。
韶粉（一两） 轻粉（一字）
以上药物研磨细末，加入炼制过的猪脂油拌匀调和如膏状，涂抹在瘢痕上。
(Scab, pronounced Ju Ya Qie, refers to the crust formed after a sore heals.)
[Haizang] If the pustules of measles or smallpox do not scorch and form dry scabs, it is because the cooling energy was lost during treatment. This is akin to grains ripening under yang energy; without the arrival of cool wind, they cannot become full and solid. Once the austere and cold energy of heaven and earth descends, all things become beautiful and solid. How is this different from the condition of measles? One must examine which meridian is affected and apply cooling methods, or induce purgation to create an austere energy, so that the pathogenic qi of the sore will not remain in a state of suppuration without scabbing. It is essential to understand this: if residual toxins are not fully cleared and the disease recurs, it often stems from this cause. (This likely refers to using Qingliang Yin [Cooling Decoction] for purgation.) Without yang and harmonious energy, seedlings cannot flower; without austere energy, flowering cannot lead to fruiting. Liu Zhu stated in *Cuangzi Jue* [Manual on Pustular Diseases]: "If smallpox eruptions resemble pus-filled sockets and refuse to heal/scab, simply prepare sugar water for the patient to drink." Director Liu noted: "I have also tried this method, but the resulting scars were white."
[Qian Yi] If scabs do not dry out by the fifth to seventh day, it is due to internal heat steaming outward, preventing the formation of dry scabs. It is appropriate to use Xuanfeng San [Promoting Wind Powder] to guide out stagnation, and grind fresh rhinoceros horn for juice to resolve toxicity. Scabbing will surely occur.
[Chen Wenzhong] Between the time when smallpox scabs have formed and full recovery, if suddenly attacked by wind-pathogens, gan-sores [ulcerative lesions associated with malnutrition/toxins] may form. These should be treated with Xionghuang San [Realgar Powder] and Mianjian San [Silkworm Cocoon Powder]. If still unhealed, the condition often erodes bones and damages tendons, leading to death.
Xionghuang San [Realgar Powder] treats gan-erosive sores on the gums of children.
Realgar (1 qian)
Bronze Green (2 qian)
Grind these two ingredients together into an extremely fine powder. For each application, sprinkle dry powder onto the sore according to its size.
Mianjian San [Silkworm Cocoon Powder] treats gan-erosive sores appearing on the body and limbs of children caused by smallpox, characterized by continuous discharge of pus and fluid.
Take silkworm cocoons from which moths have emerged. Crush raw alum [Alumen] and stuff it into the cocoon until full. Burn over charcoal fire until the alum juice is completely drained. Remove, grind into an extremely fine powder. For each application, sprinkle dry powder onto the wound.
[Qian Yi] Whenever smallpox scabs first form, continuously moisten them with rapeseed oil. If they can be peeled off, do so. If not moistened and removal is delayed, the hard scab will hide and form scars.
[Chen Wenzhong] Although the smallpox scabs have fallen off, the scars may remain dark, or present as uneven, raised flesh. One should apply scar-removing medicine.
Shao Fen [Tin Powder] (1 liang)
Qing Fen [Calomel] (1 zi)
Grind these into fine powder, mix with refined lard [Suis Medulla/Adipis Suilli Praeparatus] to form a paste, and apply to the scars.