十朝浆足应收靥，先蜡后栗似螺形，不疾不徐循次结，痂润身和顺证明。
【注】十朝浆足者，谓应收靥结痂之期，然必先如蜡黄，后如栗壳之色，痂似旋螺高
起，则为上吉之痘。不疾不徐者，谓先苍老者先收靥结痴，次苍老者次收靥结痂，从上
而下，循次而结。且更痂润有光，身和无病。为顺证无疑矣。
险证浆足色不苍，停浆不靥或烂伤，痂色紫黑不即脱，便调食美不须慌。
【注】收靥险证，谓浆虽足而色不苍也。停浆不靥，谓过期浆不靥结也。烂者，谓痘
颗溃烂也。伤者，谓痒抓伤损也。痂色紫黑者，谓痘痂色紫黑也不即脱者，谓痘虽结痂
不即脱落也。已上诸证，皆收靥险证。若二便调和，饮食强美，则险化为顺，不须惊慌
也。
不靥外剥为逆证，麸薄黑黯淡白凶，痂靥粘连终不脱，虽脱干枯亦死形。
【注】不靥外剥者，谓痘不待收靥而皮若剥去，此名倒靥，则为逆证。麸薄黯黑者，谓
痘痂形色若麸之薄、若煤之黑；淡白者，谓痂色淡白无光，故皆为凶也。粘连不脱者，谓
脓汁粘连久不脱落也。虽脱干枯者，谓痘痂虽脱而干枯不润也。此二者亦为死形也。
浆足苍老顶微焦，渐次收靥不须疗，太迟太速皆非吉，须辨虚毒湿火条。浆清皮嫩
为虚象， 赤溃臭毒热淆，浆水浸渍湿淫胜，靥速窠燥火煎熬。
【注】浆至充足，其色苍老，痘顶微焦，循次收靥，皆收靥顺证，不须疗治也。太迟
者，谓当靥不靥也。太速者，谓不当靥而靥也。皆非吉痘，然当辨其所属，或不足、或
毒盛、或属湿饮、或属火盛，须按证治之。如浆清皮嫩，此属不足难敛也。 赤溃臭，此
属毒盛敛也。浆水浸渍。此属湿盛难敛也。靥速窠燥，此属火盛难敛早也。治者须详辨之。
回浆饮
皮嫩浆清收敛迟，此证当从不足医，回浆参苓白术草，首乌白芍炙黄 。
【注】痘至收敛之时，当靥不靥，皮嫩浆薄，现证身凉、手足冷、二便不实者，此原
气不足虚证也。宜用回浆饮补之，助其收结。
回浆饮
人参 黄 （蜜炙） 白茯苓 白术（土炒） 何首乌（炙） 白芍（炒） 甘草（炙）
引用煨姜，水煎服。
大连翘饮
赤溃臭因毒盛，大连翘饮诸热清，柴芩归芍车栀草，翘蒡荆防蝉滑通。
【注】痘当收敛之时，有因毒盛而难敛者，更现证 肿而赤，溃烂而臭，通身大热，烦
渴不宁，此毒瓦斯太盛之故也。须用大连翘饮以解之。
大连翘饮
连翘（去心） 防风 牛蒡子（炒研） 荆芥 黄芩 当归 蝉蜕 柴胡 滑石 栀子 赤芍 车前子
木通 甘草（生）
引加灯心，水煎服。
除湿汤
遍体浸渍出水浆，证属湿饮在脾乡，除湿赤苓猪通泽，薄桂苍防白术羌。
【注】痘当收敛之时，有因湿盛而不得敛者。其现证轻则有孔漏浆；重则遍体溃烂，肚
腹胀，小便短，皆湿饮为患也。须用除湿汤以利之，湿除而痘自靥矣。
除湿汤
羌活 苍术（米泔水浸，炒） 防风 赤苓 猪苓 泽泻 白术（土炒） 木通 薄桂
引加生姜、灯心，水煎服。
清毒散
靥速皆因是火伤，遍体窠燥异寻常，清毒归芍连丹草，翘蒡通花生地黄。
【注】痘不当收敛之时，忽一时收敛者，更现证周身窠粒干燥，口渴发热，烦急不宁，
此毒火壅盛之故也。宜用清毒散主之。
清毒散
生地 赤芍 连翘（去心） 金银花 牛蒡子（炒研） 木通 黄连 当归 丹皮 甘草（生）
水煎服。
第十天浆液充足，应当开始收靥（痘疹结痂），痘痂先呈蜡黄色，后如栗壳色，形状似螺旋纹，结痂过程不疾不徐、依次进行，痂皮润泽、身体平和，此为顺证（病情正常发展的证候）。
【注】所谓“十朝浆足”，是指到了应收靥结痂的时期。然而痘痂必须先像蜡黄，后像栗壳的颜色，痂皮似旋螺般高起，这是上吉的痘症。所谓“不疾不徐”，是指颜色苍老的痘先收靥结痂，颜色稍差的次之收靥结痂，从上到下，依次结痂。并且痂皮润泽有光泽，身体无病，这无疑是顺证。
险证（危重证候）虽然浆液充足但颜色不苍老，停浆不结痂或溃烂损伤，痂色紫黑且不立即脱落，但只要二便调和、饮食良好，就不必惊慌。
【注】收靥期的险证，是指浆液虽足但颜色不苍老。所谓“停浆不靥”，是指过了期限浆液仍不结痂。“烂”是指痘颗溃烂。“伤”是指因瘙痒抓挠导致破损。痂色紫黑，是指痘痂颜色紫黑；“不即脱”是指痘虽结痂但不立即脱落。以上各种证候，都属于收靥期的险证。如果大小便调和，饮食强健美味，则险证可转化为顺证，不必惊慌。
不结痂且向外剥落为逆证（病情恶化、违背常理的证候），痂皮薄如麸片、色黑黯淡或色淡白均为凶兆，痂与痘粘连最终不脱落，即使脱落也是干枯的死相。
【注】“不靥外剥”是指痘不待收靥而皮若剥去，这叫倒靥，属于逆证。痂皮薄黯黑，是指痘痂形色像麸皮一样薄、像煤炭一样黑；色淡白，是指痂色淡白无光，所以都是凶兆。粘连不脱，是指脓汁粘连久不脱落。虽脱干枯，是指痘痂虽脱落但干枯不润泽。这两种情况也属于死相。
浆液充足、颜色苍老、痘顶微焦，逐渐收靥不需治疗，收靡太迟或太速都不是吉兆，必须辨别是虚毒还是湿火所致。浆液清稀、皮肤嫩弱为虚象，痘赤色溃烂发臭为毒热混杂，浆水浸渍为湿气过盛，收靥过快、痘窠干燥为火邪煎熬。
【注】浆液至充足，颜色苍老，痘顶微焦，依次收靥，都是收靥顺证，不需要治疗。太迟，是指该结痂时不结痂。太速，是指不该结痂时却结痂。都不是吉利的痘症，但应当辨别其所属原因，或是正气不足、或是毒邪旺盛、或是属湿饮、或是属火盛，必须按证治疗。如浆液清稀、皮肤嫩弱，这属于正气不足难以收敛。痘赤色溃烂发臭，这属于毒邪旺盛难以收敛。浆水浸渍，这属于湿气旺盛难以收敛。收靥过快、痘窠干燥，这属于火邪旺盛难以收敛早退。治疗者必须详细辨别。
回浆饮
皮肤嫩弱、浆液清稀、收敛迟缓，此证应当从正气不足方面医治，用回浆饮（人参、茯苓、白术、甘草、何首乌、白芍、炙黄芪）治疗。
【注】痘症到了收敛之时，该结痂却不结痂，皮肤嫩弱、浆液稀薄，现证身体凉、手脚冷、二便不成形，这是元气不足的虚证。宜用回浆饮补益，帮助其收结。
回浆饮
人参 黄芪（蜜炙） 白茯苓 白术（土炒） 何首乌（炙） 白芍（炒） 甘草（炙）
引用煨姜，水煎服。
大连翘饮
痘赤色溃烂发臭因毒邪旺盛，大连翘饮可清诸热，方含柴胡、黄芩、当归、白芍、车前子、栀子、甘草、连翘、牛蒡子、荆芥、防风、蝉蜕、滑石、木通。
【注】痘症当收敛之时，有因毒邪旺盛而难以收敛的，更现证痘肿而赤色，溃烂而发臭，通身大热，烦躁口渴不安，这是毒瓦斯太盛的缘故。须用大连翘饮来解除。
大连翘饮
连翘（去心） 防风 牛蒡子（炒研） 荆芥 黄芩 当归 蝉蜕 柴胡 滑石 栀子 赤芍 车前子 木通 甘草（生）
引加灯心草，水煎服。
除湿汤
遍体浸渍出水浆，证属湿饮在脾脏，除湿汤含赤茯苓、猪苓、木通、泽泻、薄桂、苍术、防风、白术、羌活。
【注】痘症当收敛之时，有因湿气旺盛而不能收敛的。其现证轻则有孔漏出浆液；重则遍体溃烂，肚腹胀满，小便短少，都是湿饮为患。须用除湿汤来利湿，湿气去除而痘自然结痂。
除湿汤
羌活 苍术（米泔水浸，炒） 防风 赤茯苓 猪苓 泽泻 白术（土炒） 木通 薄桂
引加生姜、灯心草，水煎服。
清毒散
收靥过快皆因火邪损伤，遍体痘窠干燥异于寻常，清毒散含当归、白芍、连翘、丹皮、甘草、连翘、牛蒡子、木通、花生、生地。
On the tenth day, when the pustules are full of fluid, crusting (scabbing) should begin. The scabs first appear waxy yellow, then take on the color of chestnut shells, resembling a spiral shape. The process of forming scabs proceeds neither too fast nor too slow, occurring in order; with moist scabs and a harmonious body, this indicates a favorable course (Shun Zheng).
[Note] "Full fluid on the tenth day" refers to the period when crusting is expected. However, the scabs must first resemble waxy yellow, then the color of chestnut shells, rising like a spiral shell; this represents an auspicious outcome for smallpox/rash. "Neither too fast nor too slow" means that those with darker, older-looking lesions crust first, followed by those slightly less mature, proceeding from top to bottom in sequence. Furthermore, if the scabs are lustrous and moist, and the body is free of disease, this is undoubtedly a favorable course.
In dangerous courses (Xian Zheng), although the fluid is sufficient, the color is not dark/old; the fluid stagnates without crusting, or the lesions ulcerate or are damaged. If the scabs are purple-black and do not shed immediately, but bowel movements are regular and appetite is good, there is no need for panic.
[Note] Dangerous courses during crusting refer to cases where fluid is sufficient but the color lacks maturity. "Stagnant fluid without crusting" means the fluid fails to crust after the appropriate time. "Ulceration" refers to the breaking down of pustules. "Damage" refers to injury caused by scratching due to itching. Purple-black scabs indicate the scabs are purple-black; "not shedding immediately" means the scabs form but do not fall off promptly. All the above conditions belong to dangerous courses during crusting. If urination and defecation are harmonious, and diet is robust and delicious, the dangerous course transforms into a favorable one, requiring no alarm.
Failure to crust accompanied by external peeling constitutes a reverse course (Ni Zheng - adverse/unfavorable progression). Scabs thin as bran, dark/black and dull, or pale white are ominous signs. Adhesion of scabs preventing detachment, or even if detached, appearing dry and withered, indicates a fatal prognosis.
[Note] "Failure to crust with external peeling" means the skin peels off before proper crusting occurs; this is called inverted crusting (Dao Ye) and constitutes a reverse course. Thin, dark, and black scabs mean the scabs are thin like bran and black like coal; pale white means the scabs are pale white and lack luster; thus, all are ominous. Adhesion preventing detachment means pus causes prolonged adhesion. Even if detached, dryness and withering means the scabs fall off but remain dry and unmoistened. Both these scenarios indicate a fatal prognosis.
When fluid is sufficient, color is mature/dark, and the apex of the lesion is slightly scorched, gradual crusting requires no treatment. Crusting that is too late or too early is not auspicious; one must differentiate whether it stems from deficiency-toxicity or damp-heat. Clear fluid and tender skin indicate a deficiency pattern; redness, ulceration, and foul odor indicate toxic heat confusion; fluid soaking indicates excessive dampness; rapid crusting with dry fossae indicates fire scorching.
[Note] When fluid reaches sufficiency, the color is mature, the lesion apex is slightly scorched, and crusting proceeds sequentially, these are all favorable courses for crusting, requiring no treatment. "Too late" means failing to crust when one should. "Too early" means crusting when one should not. Neither is auspicious, but the underlying cause must be differentiated: either deficiency, excess toxicity, damp-fluid retention, or excess fire. Treatment must follow the specific syndrome. For example, clear fluid and tender skin indicate deficiency making consolidation difficult. Redness, ulceration, and foul odor indicate excess toxicity making consolidation difficult. Fluid soaking indicates excess dampness making consolidation difficult. Rapid crusting with dry fossae indicates excess fire making premature consolidation difficult. Practitioners must distinguish these carefully.
Hui Jiang Yin (Return Fluid Decoction)
Tender skin, clear fluid, and delayed consolidation require treatment addressing deficiency. Use Hui Jiang Yin (Renshen, Fuling, Baizhu, Gancao, Heshouwu, Baishao, Zhi Huangqi).
[Note] At the stage of consolidation, if crusting fails to occur, skin is tender, fluid is thin, and symptoms include cool body temperature, cold extremities, and loose stools, this is a deficiency syndrome due to insufficient Yuan Qi (Original Qi). It is suitable to use Hui Jiang Yin to tonify and assist consolidation.
Hui Jiang Yin (Return Fluid Decoction)
Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix, honey-fried), Bai Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma, soil-fried), He Shouwu (Polygoni Multiflori Radix, processed), Baishao (Paeoniae Radix Alba, stir-fried), Gancao (Licorice Root, honey-fried).
Decoct with Wei Jiang (Baked Ginger) as an adjunct, taken orally.
Da Liao Qiao Yin (Large Forsythia Decoction)
Redness, ulceration, and foul odor due to excess toxicity can be cleared of various heats using Da Liao Qiao Yin. Ingredients include Chaihu, Huangqin, Danggui, Baishao, Cheqianzi, Zhizi, Gancao, Liaoqiao, Niubangzi, Jingjie, Fangfeng, Chantui, Huashi, Mutong.
[Note] During the crusting stage, some cases fail to consolidate due to excess toxicity. Symptoms may include swollen, red lesions, ulceration with foul odor, generalized high fever, restlessness, thirst, and agitation. This is due to excessive toxic vapors. Da Liao Qiao Yin should be used to resolve this.
Da Liao Qiao Yin (Large Forsythia Decoction)
Liaoqiao (Forsythiae Fructus, heart removed), Fangfeng (Saposhnikoviae Radix), Niubangzi (Arctii Fructus, stir-fried and crushed), Jingjie (Schizonepetae Spica), Huangqin (Scutellariae Radix), Danggui (Angelicae Sinensis Radix), Chantui (Cicadae Periostracum), Chaihu (Bupleuri Radix), Huashi (Talcum), Zhizi (Gardeniae Fructus), Chi Shao (Paeoniae Radix Rubra), Cheqianzi (Plantaginis Semen), Mutong (Akebiae Caulis), Gancao (Licorice Root, raw).
Add Dengxincao (Junci Medullae) as an adjunct, decoct in water, and take orally.
Chu Shi Tang (Dampness-Removing Decoction)
Generalized soaking with oozing fluid indicates damp-fluid affecting the Spleen. Chu Shi Tang contains Chi Ling, Zhuling, Mutong, Zexie, Hougui, Cangzhu, Fangfeng, Baizhu, and Qianghuo.
[Note] During the crusting stage, some cases fail to consolidate due to excess dampness. Mild cases show leaking fluid from pores; severe cases show generalized ulceration, abdominal distension, and short urination. These are caused by damp-fluid pathogenic factors. Chu Shi Tang should be used to promote diuresis and remove dampness; once dampness is eliminated, the rash will naturally crust.
Chu Shi Tang (Dampness-Removing Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Cangzhu (Atractylodis Rhizoma, soaked in rice wash water and stir-fried), Fangfeng (Saposhnikoviae Radix), Chi Ling (Poria cum Rosa), Zhuling (Polypori Umbilicati Mycelium), Zexie (Alismatis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, soil-fried), Mutong (Akebiae Caulis), Hougui (Cinnamomi Cortex, thin).
Add Shengjiang (Fresh Ginger) and Dengxincao (Junci Medullae) as adjuncts, decoct in water, and take orally.
Qing Du San (Toxin-Clearing Powder)
Rapid crusting is often due to fire injury. Generalized dryness of the lesion fossae is abnormal. Qing Du San contains Danggui, Baishao, Liaoqiao, Danpi, Gancao, Liaoqiao, Niubangzi, Mutong, Huaisheng, and Shengdi.
[Note] When the rash should not be crusting, sudden crusting occurs. Symptoms include generalized dryness of the lesion fossae, thirst, fever, and restlessness/agitation. This is due to congested and excessive toxic fire. Qing Du San is indicated.
Qing Du San (Toxin-Clearing Powder)
Shengdi (Rehmanniae Radix Preparata), Chi Shao (Paeoniae Radix Rubra), Liaoqiao (Forsythiae Fructus, heart removed), Jinyinhua (Lonicerae Japonicae Flos), Niubangzi (Arctii Fructus, stir-fried and crushed), Mutong (Akebiae Caulis), Huanglian (Coptidis Rhizoma), Danggui (Angelicae Sinensis Radix), Danpi (Moutan Cortex), Gancao (Licorice Root, raw).
Decoct in water and take orally.