【瘢赤黑】〔万〕疮痂落后，其面瘢或赤或黑者，用四白灭瘢散，临睡以清蜜水
调搽面上，至晓以水涤去之，自然白莹，脱去更宜爱护，不得早见风日，经年不灭。如疮瘢突起成凸者，此热毒未
尽，解毒防风汤主之（见形发热），外更用蚬子内水摩之。如陷下成凹者，此脾胃虚不能长肌肉也，人参白术散（痘渴）
加黄 主之。
四白灭瘢散
白芷 白附子 白僵蚕 鹰矢 白密陀僧（各等分）
共研极细末。以水调搽面 ，神效。
韶粉散 治痘疮才愈，毒瓦斯未尽，疮痂虽落，其瘢犹黯，或凸凹肉起，当用此药涂之。
韶粉（一两） 轻粉（一钱）
上研细末。猪骨髓熬熟调成膏，薄涂疮瘢上。如痘疹欲落，当灭瘢痕，一名灭瘢散。
【瘢黑暗】凡疮瘢头面浑身并黑暗者，未可便说无事，犹恐日前未甚作脓，收靥太急，此倒靥归肾也。但察其表里，
如壮热大渴未除，烦闷昏睡少食，或大便不通，或自利，此真倒靥归肾也，若身温暖爽快，食渐加，大小便调者，
此疮瘢本色，无虑也。
【痂不脱】〔万〕痘疮收后，其痂自脱者佳，不脱，以百花膏润之，令其速脱，稍迟则干硬，深入肌肉，经久方脱，
遂成瘢痕。然久而不脱者，脾胃虚也，人参白术散加黄 、官桂主之，不可 掐剥去，若不禁手，反伤皮肤，
复灌作疮，番覆溃烂，一时难愈，其后多成疥癞也。〔黄〕痘疮粘着皮肉，不肯脱落，此表虚也，尤
当禁忌，以防异变，用调元固表汤主之。
调元固表汤
黄 人参 当归 甘草 蝉蜕
人参固肌汤 治痘表发太过，致肌肉不密，痘痂粘肉，久不落者。
人参 黄 甘草 当归 蝉蜕（各等分） 糯米（一撮）
上，用水煎服。
人参清神汤 治痘痂不落，昏迷沉睡者。
人参 黄 甘草 当归 白术（土炒） 麦门冬 陈皮 酸枣仁 黄连（酒炒） 茯苓
上，各等分，加枣子、糯米，水煎服。
马齿苋散 治痘痂不落，成 痕者。
马齿苋（捣汁） 猪脂膏 石蜜
三味共熬成膏，涂肿处。
凡疮痂日久，当脱不脱者，胸背手足无妨，惟面上不脱，必成瘢陷，未脱者以
百花膏润之（收靥），令其易脱，脱尽之后，瘢痕黑黯者，以四白灭瘢散涂之。
羊 骨髓 治痘痂欲落不落，瘢痕。
羊 骨髓一两，炼入轻粉一钱，研成膏，涂之。
如收靥既迟，疮痂不落，昏昏喜睡者，此邪气已退，正气未复，脾胃虚弱，宜调元汤（即参 饮见
大法）加麦门冬，合安神丸（痘烦躁）。或只用酸枣仁汤（烦躁）缓缓调理，待气血平复，荣卫和畅而安矣。
【瘢肿成脓】痘疮收靥之后，痂皮尽脱，曾见瘢痕凸起，复作脓窠，依旧结一层 子者，或因收靥太
骤，毒瓦斯未尽，或因误服温补之药，多啖肥甘之物，饮酒喜食煎炒辛热，或因出风太早，荣卫郁而不通，皆
能复成此证，亦与前日一般，但无苦耳，若此者，毒邪外散，决无留毒之患。痘疮遍身溃烂不结痂者，倒靥也。或三
五处肿灌溃烂，不结痂者，疳蚀疮也。若已正靥，痂起自脱。或面上，或手足，或片结硬疮，头虽焦，中蓄脓浆者，
此是原出疮子之初，其处太密，糊涂成片，无复颗粒，所以毒壅于里，不能起发作脓结痂也，但用灭瘢救苦散（收靥）
和百花膏（收靥）涂之，待脓尽痂起自愈。或手足腕膝之间，疮窠连串作大一块，脓化作水，停蓄于中，恰
如囊袋，皮不破，水不去，日久只如是者，此里面肌肉已好，原日疮皮、剩于外也，宜用针决去其水，自干脱矣。
【能食不能食】疮痂既落，中气暴虚，多不能食，必藉人参白术散去葛根，加陈皮、木香、以调养之。其间或有疮
痂起而能食者，是胃中宿有蕴热故也，盖胃热则消谷，所以能食，其人必大便稍秘，或大便难，当用三黄丸利之，
否则恐胃热不去，郁为口臭，齿腐生风之证，流散四肢，则发为痈疽肿毒。然有一等脾胃素壮
实者，平素能食，大便亦不至有秘结之患，此又不可一概论也。
【瘢痕赤白】痘痕赤白，各有所因，治法亦异。凡痕赤而作痒，血虚而有热也，
用四味牡丹皮。赤而作痛，余热也，用四君、连翘、金银花。若发热而大便调和者，
脾胃虚热也，用五味异功散。若发热而大便秘结者，肠胃内热也，用《圣济》犀角地黄汤。若母有肝火，用加味
逍遥散。若母有郁怒，用加味归脾汤，佐以加味逍遥散治之。白者 属气虚而血衰也，宜固元气为本。痒而作渴者，
气血俱虚也，十全大补汤之类。乳食减少，四肢倦怠者，中气虚也，五味异功散之类。气虚发热者，
补中益气汤之类。血虚发热者，当归补血汤之类。须参兼变之证治之。此证若服药而渐红活者可治，色不转者不治，
虽经年后多患泻利而死，若妄投攻伐，祸在反掌。一小儿痘疮如期而愈，痕赤如赭。余谓此乳母有热也，诊之，果
有肝脾郁火，先用加味逍遥散四剂，与母服之，子各饮少许而并愈。一小儿痘痕色赤作痛，热渴喜
冷，大便不利。先用前胡枳壳散，便利渴止，再用《圣济》犀角地黄汤而安，又用芹菜汁而靥。一小儿十六岁，痘痕白，
用独参汤数斤，色渐如旧，又用地黄丸、大补汤、而安。
【禁忌】痘疮新瘥之后，气血未复，视之未靥，尤加调护可也。盖痂皮起落，肌肉新嫩，不宜澡洗，增减衣服则表
已虚，寒暑之气易袭也。疮毒内作，脏腑俱伤，毒虽外散，肠胃已弱，不宜饮冷，伤饥过饱则里气虚，饮食之物易
伤也，时俗不知此理，谓之已痊，再无他变，怠玩纵弛，致生后灾，一旦病生，悔之晚矣。
【 杌痘】〔袁〕按∶孙氏揭 杌痘以垂世，而不注解其详，迨黄石峰尽注明白。且痘澄脓结痂，自头抵足，
靥已脱矣，又身发火热，旧靥盆处，重出一番痘，疏囊聚脓，痛愈加甚，服药调护，庶免夭亡，倘饮食不节，风寒不
避，邪气感迫，囊破溃烂，肚腹渐胀，阴阳不分，死在旦夕矣。若起于头面者，须防陋井涌泉（陋井、腮颊穿陋，
涌泉、眼沿陋）。之患，起于背腹者，应虑蜂螫沉石之虑（蜂螫，遍身刺痛也，沉石，皮肉四烂也），起于手足者，
不免有罄笔之罹，起于阳球者，预宜防脱囊之害。玉函云∶天花结果庆奇全， 杌归门痘倒颠，不是渠塘番汹浪，
便教关节结痈缠。为父母者，庶几慎之。
【瘢痕呈赤黑色】〔万全〕痘疮结的痂皮脱落后，面部的瘢痕有的发红、有的发黑，使用四白灭瘢散，临睡前用清蜜水调匀涂抹在面部，到第二天早晨用水洗净，自然会变得洁白晶莹。痂皮脱落后更应注意爱护，不能过早接触风日，即使经过一年瘢痕不消退也没关系。如果疮瘢突起形成凸起的，这是热毒没有清除干净，主用解毒防风汤治疗（参见“形发热”章节），外部再用蚬子壳内的水摩擦患处。如果凹陷形成凹坑的，这是脾胃虚弱不能生长肌肉所致，用人参白术散（参见“痘渴”章节）加黄芪为主治疗。
四白灭瘢散
白芷 白附子 白僵蚕 鹰矢白 白密陀僧（各等分）
共同研磨成极细粉末。用水调匀涂抹面部，效果神奇。
韶粉散 治疗痘疮刚刚痊愈，毒气未尽，疮痂虽然脱落，但瘢痕仍然暗哑，或者凹凸不平、肉质隆起，应当使用此药涂抹。
韶粉（一两） 轻粉（一钱）
以上研成细末。用猪骨髓熬熟调成膏状，薄薄地涂在疮瘢上。如果痘疹快要脱落，想要消除瘢痕，又名灭瘢散。
【瘢痕黑暗】凡是疮瘢在头面、浑身都呈现黑暗颜色的，不可以立即说没有问题，恐怕是因为前几天化脓不明显，收靥（结痂愈合）太快，这是倒靥归肾的表现。只要观察其表里情况，如果壮热大渴未除，烦闷昏睡、食欲减少，或者大便不通，或者自利腹泻，这是真正的倒靥归肾；如果身体温暖爽快，饮食逐渐增加，大小便正常，这是疮瘢的本色颜色，无需担忧。
【痂皮不脱落】〔万全〕痘疮收敛后，痂皮自然脱落是好的，如果不脱落，用百花膏滋润它，让它快速脱落，稍微延迟就会干硬，深入肌肉，很久才能脱落，最终形成瘢痕。然而长时间不脱落的，是脾胃虚弱，用人参白术散加黄芪、官桂为主治疗，不可用手掐剥去除，如果忍不住手去抠剥，反而损伤皮肤，再次感染化脓溃烂，反复溃烂，一时难以愈合，后来多会变成疥癞。〔黄〕痘疮粘着皮肉，不肯脱落，这是表虚，尤其应当禁忌，以防发生异变，主用调元固表汤治疗。
人参固肌汤 治疗痘表发散太过，导致肌肉不紧密，痘痂粘肉，久久不脱落的情况。
人参 黄芪 甘草 当归 蝉蜕（各等分） 糯米（一撮）
以上，用水煎服。
人参清神汤 治疗痘痂不脱落，昏迷沉睡的情况。
人参 黄芪 甘草 当归 白术（土炒） 麦门冬 陈皮 酸枣仁 黄连（酒炒） 茯苓
以上，各等分，加枣子、糯米，水煎服。
马齿苋散 治疗痘痂不脱落，形成瘢痕的情况。
马齿苋（捣汁） 猪脂膏 石蜜
三味共同熬成膏状，涂在肿胀处。
凡是疮痂日子久了，应当脱落却不脱落的，胸背手足无妨，只有脸上不脱落，必定形成瘢痕凹陷，未脱落的用百花膏滋润（参见“收靥”章节），让它容易脱落，脱尽之后，如果瘢痕黑黯，用四白灭瘢散涂抹。
羊骨髓 治疗痘痂欲落不落，瘢痕。
羊骨髓一两，炼入轻粉一钱，研成膏，涂抹。
如果收靥既迟，疮痂不脱落，昏昏喜睡，这是邪气已退，正气未复，脾胃虚弱，宜用调元汤（即参苓饮，见大法章节）加麦门冬，合安神丸（痘烦躁章节）。或者只用酸枣仁汤（烦躁章节）缓缓调理，待气血平复，营卫和畅而安定了。
【瘢痕肿成脓】痘疮收靥之后，痂皮全部脱落，曾见到瘢痕凸起，又化作脓窠，依旧结一层痂子的，可能是因为收靥太急骤，毒气未尽，或者因为误服温补的药物，多吃肥甘之物，饮酒喜欢食用煎炒辛热的食物，或者因为出风太早，营卫郁滞不通，都能再次形成此证，也与前日一般，只是没有痛苦罢了，像这种情况，毒邪外散，决不会有留毒的隐患。痘疮遍身溃烂不结痂的，是倒靥。或者三五处肿胀灌脓溃烂，不结痂的，是疳蚀疮。如果已经正靥，痂起自然脱落。或者在脸上，或者在手脚，或者成片结成硬疮，头虽然焦枯，中间蓄积脓浆的，这是原来出的疮子之初，那个地方太密集，糊涂成片，不再有颗粒，所以毒气壅塞在内部，不能起发作脓结痂，只需用灭瘢救苦散（收靥章节）和百花膏（收靥章节）涂抹，等待脓尽痂起自愈。或者在手足腕膝之间，疮窠连串作大一块，脓化作水，停蓄在其中，恰如囊袋，皮不破，水不去，日子久了只是这样的，这是里面的肌肉已经好了，原来的疮皮剩于外面，宜用针刺破排出积水，自然会干枯脱落。
【能食与不能食】疮痂既然脱落，中气突然虚弱，大多不能进食，必须借助人参白术散去葛根，加陈皮、木香，来调养它。其中或者有疮痂起了却能进食的，是胃中宿有蕴热的原因，因为胃热则消谷，所以能进食，其人必定大便稍秘，或者大便困难，当用三黄丸通利它，否则恐怕胃热不去，郁积成为口臭、齿腐生风的证候，流散四肢，则发为痈疽肿毒。然而有一类脾胃素来强壮结实的人，平时能进食，大便也不至于有秘结的患难，这又不可以一概而论。
【瘢痕赤白】痘痕赤白，各有原因，治法也不同。凡是痕赤且发痒，是血虚而有热，用四味牡丹皮。赤且疼痛，是余热，用四君子汤、连翘、金银花。如果发热而大便调和的，是脾胃虚热，用五味异功散。如果发热而大便秘结的，是肠胃内热，用《圣济》犀角地黄汤。如果母亲有肝火，用加味逍遥散。如果母亲有郁怒，用加味归脾汤，佐以加味逍遥散治疗。白色的属于气虚而血衰，宜以固元气为本。痒且口渴的，是气血俱虚，十全大补汤之类。乳食减少，四肢倦怠的，是中气虚，五味异功散之类。气虚发热的，补中益气汤之类。血虚发热的，当归补血汤之类。须参考兼变之证治疗。此证如果服药而渐渐红活的可治，颜色不转变的不治，虽然经过多年也多患泻利而死，如果妄投攻伐药物，祸患就在反掌之间。一个小儿痘疮如期而愈，痕赤如赭石。我认为这是乳母有热，诊察发现，果然有肝脾郁火，先用加味逍遥散四剂，给母亲服用，孩子各饮少许而并愈。一个小儿痘痕色赤作痛，热渴喜冷，大便不利。先用前胡枳壳散，便利渴止，再用《圣济》犀角地黄汤而安，又用芹菜汁而靥。一个小儿十六岁，痘痕白，用独参汤数斤，颜色渐渐如旧，又用地黄丸、大补汤，而安。
【禁忌】痘疮新近痊愈之后，气血未恢复，视之未靥，尤其加以调护是可以的。因为痂皮起落，肌肉新嫩，不宜洗澡清洗，增减衣服则表已虚，寒暑之气容易侵袭。疮毒内作，脏腑俱伤，毒虽外散，肠胃已弱，不宜饮冷，伤饥过饱则里气虚，饮食之物容易受伤，时俗不知道这个道理，称为已痊愈，再无其他变故，怠慢纵弛，导致后灾，一旦病生，后悔晚矣。
【杌痘】〔袁〕按：孙氏揭示杌痘以传世，而不注解其详细，等到黄石峰完全注明明白。且痘澄脓结痂，从头抵足，靥已脱落，又身发火热，旧靥盆处，重出一番痘，疏囊聚脓，痛愈加甚，服药调护，庶免夭亡，倘若饮食不节，风寒不避，邪气感迫，囊破溃烂，肚腹渐胀，阴阳不分，死在旦夕了。如果起于头面的，须防陋井涌泉（陋井、腮颊穿陋，涌泉、眼沿陋）的患难，起于背腹的，应虑蜂螫沉石的忧虑（蜂螫，遍身刺痛也，沉石，皮肉四烂也），起于手足的，不免有罄笔的罹难，起于阳球的，预宜防脱囊的危害。玉函云：天花结果庆奇全，杌归门痘倒颠，不是渠塘番汹浪，便教关节结痈缠。作为父母，或许谨慎对待。
[Scar Red and Black] [Wan] After the scabs of smallpox fall off, if the scars on the face are red or black, apply Sibai Mieban San (Four Whites Scar-Removing Powder). Mix with clear honey water before sleep, rub onto the face, and wash off with water at dawn. Naturally, it will become white and lustrous. After the scab falls off, extra care should be taken to avoid exposure to wind and sunlight early on; even if the scar does not fade after a year, it is acceptable. If the scar protrudes and becomes convex, this indicates that heat-toxin has not been fully cleared; treat primarily with Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) (see "Shape Fever"), and externally rub with the inner water of clam shells. If the scar is depressed and concave, this is due to Spleen-Stomach deficiency failing to regenerate muscle tissue; treat primarily with Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) (see "Smallpox Thirst") plus Huangqi (Astragalus Root).
Sibai Mieban San (Four Whites Scar-Removing Powder)
Baizhi (Angelicae Dahuricae Radix), Baifuzi (Aconiti Kusnezoffii Radix), Baijiangcan (Bombyx Batryticatus), Yingshibai (Columbae Excrement Album), Baimituoseng (Lithargyri Preparatum) (equal parts)
Grind into an extremely fine powder. Mix with water and apply to the face; miraculous effect.
Shaofen San (Pearl White Powder) Treats cases where smallpox has just healed, but toxin remains. Although scabs have fallen, scars remain dark, or there are凹凸 (concavities and convexities) with raised flesh. Apply this medicine topically.
Shaofen (1 liang), Qingfen (Calomel, 1 qian)
Grind into fine powder. Cook pig marrow into a paste and mix with the powder. Apply thinly to the scars. If vesicles are about to fall and one wishes to eliminate scars, this is also known as Mieban San (Scar-Removing Powder).
[Dark Scars] Whenever scars on the head, face, and whole body appear dark, do not immediately assume there is no problem. It is feared that previously pus formation was insufficient and the healing/crusting (Shouye) was too rapid, indicating "Dao Ye Gui Shen" (Inverse Crusting Returning to Kidney). Observe the exterior and interior conditions: if there is high fever and severe thirst unrelieved, restlessness, drowsiness, and poor appetite, or constipation, or spontaneous diarrhea, this is true "Dao Ye Gui Shen". If the body feels warm and comfortable, food intake gradually increases, and bowel/bladder movements are normal, this is the natural color of the scar; no need to worry.
[Scabs Not Falling Off] [Wan] After smallpox收敛 (recedes/heals), it is auspicious for scabs to fall off naturally. If they do not fall off, use Baihua Gao (Hundred Flowers Ointment) to moisten them, allowing them to fall off quickly. Delaying causes them to become dry and hard, penetrating deep into the muscle, taking a long time to fall off, eventually forming scars. However, if they remain for a long time without falling, it is due to Spleen-Stomach deficiency; treat primarily with Renshen Baizhu San plus Huangqi (Astragalus Root) and Guigui (Cinnamon Twig). Do not pick or peel them off by hand; if one cannot resist picking, it damages the skin, leading to reinfection and suppuration, repeated ulceration, difficult healing, and potentially resulting in scabies-like conditions later. [Huang] Smallpox scabs adhering to the skin and refusing to fall off indicate Exterior Deficiency. One must strictly observe taboos to prevent abnormal changes; treat primarily with Tiaoyuan Gubiao Tang (Regulate Origin and Secure Exterior Decoction).
Tiaoyuan Gubiao Tang (Regulate Origin and Secure Exterior Decoction)
Huangqi (Astragali Radix), Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Chantui (Cicadae Periostracum)
Renshen Guji Tang (Ginseng Solidify Muscle Decoction) Treats cases where the exterior was dispersed too excessively during smallpox, causing loose muscle tissue, adhesion of scabs to flesh, and prolonged non-falling of scabs.
Renshen (Ginseng Radix), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Chantui (Cicadae Periostracum) (equal parts), Nuomi (Glutinous Rice, a handful)
Decoct in water and take orally.
Renshen Qingshen Tang (Ginseng Clear Spirit Decoction) Treats cases where scabs do not fall off, accompanied by coma and deep sleep.
Renshen (Ginseng Radix), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma - soil-fried), Maimendong (Ophiopogonis Radix), Chenpi (Citri Reticulatae Pericarpium), Suanzaoren (Ziziphi Spinosae Semen), Huanglian (Coptidis Rhizoma - wine-fried), Fuling (Poria)
Equal parts, add dates and glutinous rice, decoct in water and take orally.
Machixian San (Portulaca Powder) Treats cases where scabs do not fall off and scars form.
Machixian (Portulacae Herba - crushed for juice), Zhizhi Gao (Pork Lard Ointment), Shimii (Rock Sugar)
Boil the three ingredients together into an ointment and apply to swollen areas.
For any scabs that have been present for a long time and should fall off but do not: those on the chest, back, hands, and feet are not problematic. Only those on the face will inevitably form depressed scars. Moisten the unfallen scabs with Baihua Gao (Hundred Flowers Ointment) (see "Healing/Crusting") to facilitate falling off. After complete removal, if scars are dark/black, apply Sibai Mieban San.
She Marrow Treats smallpox scabs that want to fall off but do not, and scars.
She Marrow (1 liang), refined with Qingfen (Calomel, 1 qian), ground into an ointment, apply topically.
If healing/crusting is delayed, scabs do not fall off, and the patient is drowsy and sleepy, this indicates pathogenic qi has retreated but healthy qi has not yet recovered, and Spleen-Stomach is weak. Use Tiaoyuan Tang (i.e., Shenling Yin, see General Principles) plus Maimendong (Ophiopogonis Radix), combined with Anshen Wan (Calm Spirit Pill) (see "Smallpox Irritability"). Or simply use Suanzaoren Tang (Jujube Seed Decoction) (see "Irritability") for slow regulation, waiting for Qi and Blood to stabilize and Ying-Wei (Nutritive and Defensive Qi) to harmonize before peace is restored.
[Scar Swelling and Suppuration] After smallpox healing/crusting, when all scabs have fallen, sometimes scars protrude and turn into pustules again, forming a new layer of crust. This may be due to healing being too rapid with residual toxin, or mistakenly taking warming/tonifying medicines, consuming too much rich/greasy food, drinking alcohol, liking fried/spicy/hot foods, or exposing to wind too early, causing Ying-Wei stagnation and blockage. All can lead to this condition again. It is similar to previous days but without pain. In such cases, pathogenic toxins disperse outward, so there is no risk of retained toxin. If smallpox ulcers all over the body fail to crust, it is "Dao Ye" (Inverse Crusting). If only 3-5 areas swell, suppurate, and ulcerate without crusting, it is "Gan Shi Chuang" (Kwashiorkor-like Ulcer). If proper crusting has occurred and scabs fall off naturally, or if on the face, hands, feet, or成片 (in patches) hard crusts form with burnt heads but pus accumulation inside, this is because the original pustules were too dense, merging into a mass without distinct grains, causing toxin congestion internally, preventing pus formation and crusting. Apply Mieban Jiuku San (Scar-Removing and Bitterness-Saving Powder) mixed with Baihua Gao (Hundred Flowers Ointment) until pus drains and scabs rise, then it heals itself. If between wrists/knees, pustules merge into a large mass, turning to fluid, accumulating like a sac without breaking skin, persisting for days, this indicates internal muscle has healed, leaving old skin outside. Puncture with a needle to drain fluid, and it will dry and fall off naturally.
[Able vs. Unable to Eat] After scabs fall off, Middle Qi suddenly becomes deficient, often leading to inability to eat. One must rely on Renshen Baizhu San minus Gegen (Puerariae Radix), plus Chenpi (Citri Reticulatae Pericarpium) and Muxiang (Aucklandiae Radix) for nourishment. Occasionally, some have rising scabs but can still eat; this is due to latent heat in the Stomach. Stomach Heat promotes digestion, hence the ability to eat. Such patients usually have slight constipation or difficulty defecating. Treat with Sanhuang Wan (Three Yellows Pill) to purge. Otherwise, Stomach Heat may linger, becoming halitosis, rotting teeth, or wind-generation syndromes, spreading to limbs causing carbuncles and toxic swellings. However, those with strong constitutions who normally eat well and have no constipation issues cannot be generalized in this manner.
[Red and White Scars] Red and white smallpox scars have different causes and treatments. Red scars with itching indicate Blood Deficiency with Heat; use Siwei Mudan Pi (Four Ingredients Moutan Bark). Red scars with pain indicate residual heat; use Sijunzi Tang (Four Gentlemen Decoction), Lianqiao (Forsythiae Fructus), and Jinyinhua (Lonicerae Japonicae Flos). If fever accompanies normal bowel movements, it is Spleen-Stomach Deficient Heat; use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder). If fever accompanies constipation, it is Intestinal-Stomach Internal Heat; use Shengji Juexiao Dihuang Tang (Star-Rhino-Horn Rehmannia Decoction from Shengji Tongpu). If the mother has Liver Fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If the mother has depression/anger, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction), assisted by Jiawei Xiaoyao San. White scars belong to Qi Deficiency and Blood Decline; prioritize securing Original Qi. Itching with thirst indicates Qi and Blood both deficient; use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) etc. Reduced milk/food intake and limb fatigue indicate Middle Qi Deficiency; use Wuwei Yigong San etc. Qi Deficiency with fever: Buchong Yiqi Tang (Tonify Middle and Augment Qi Decoction) etc. Blood Deficiency with fever: Danggui Buxue Tang (Angelica Tonify Blood Decoction) etc. Must consider concurrent/variable syndromes. If symptoms improve and become ruddy/red after medication, it is treatable; if color does not change, it is untreatable, and death from diarrhea may occur years later. Reckless use of purging/attacking drugs brings disaster instantly. A child's smallpox healed on schedule, leaving red-as-hematite scars. I reasoned this was due to maternal heat. Diagnosis confirmed Liver-Spleen Depressed Fire. First gave Jiawei Xiaoyao San (4 doses) to the mother; the child drank a little, and both recovered. Another child had red, painful scars, fever/thirst preferring cold, and constipation. First used Qianhu Zhike San (Peucedanum and Aurantium Powder); once bowels moved and thirst stopped, used Shengji Juexiao Dihuang Tang to calm, then celery juice to heal. A 16-year-old child had white scars; used Dushen Tang (Single Ginseng Decoction) for several jin, color gradually returned to normal, then used Dihuang Wan (Rehmannia Pill) and Dabu Tang (Great Tonifying Decoction) to recover.
[Taboos] After recent smallpox recovery, Qi and Blood are not yet restored. Even if visually healed, extra care is essential. As scabs rise and fall, new muscle tissue is tender; bathing is inadvisable. Changing clothes exposes the weakened Exterior to Cold/Heat pathogens. Toxin acts internally, damaging Zang-Fu organs. Although toxin disperses outward, intestines/stomach are weak; cold drinks are inadvisable. Hunger or overeating weakens Interior Qi, making food hard to digest. Laypeople ignore this, calling it "fully cured" with no further risks, leading to negligence and subsequent disasters. Once illness strikes, regret comes too late.
[Ni Dou / Reverse Smallpox] [Yuan] Note: Sun Shi revealed Ni Dou for transmission but did not annotate details in depth; Huang Shifeng clarified everything. When pus clears and scabs form from head to toe, and crusts have fallen, yet fever arises again, and new smallpox erupts at old crust sites, with sparse sacs gathering pus and increasing pain, medication and care may prevent premature death. If diet is irregular and wind-cold avoided poorly, pathogenic qi forces invasion, sacs break and ulcerate, abdomen swells, Yin/Yang separate, and death occurs within a day. If arising on the head/face, fear "Lou Jing Yong Quan" (Lou Jing: cheek perforation; Yong Quan: eye margin perforation). If on back/abdomen, fear "Feng Zhe Chen Shi" (Feng Zhe: whole-body stabbing pain; Chen Shi: four-sided rot of skin/flesh). If on hands/feet, suffer endless suffering. If on genitals, fear testicular detachment. Yu Han says: "Celestial flowers bear fruit, celebrating miraculous completion; Ni Dou returns to the gate, smallpox inverted. Not channel pond waves surging, but joints knotting into carbuncles缠绕." Parents should be cautious.