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Death. In years when smallpox breaks out, corpses litter the roads, and people are completely unaware of the tragedy. These malicious physicians harbor hearts like jackals and wolves.

Since ancient times, renowned masters in treating smallpox have numbered more than twenty, each possessing precise and outstanding insights to supplement the deficiencies of their predecessors. Although each had their own biases, these were actually complementary to one another.

A physician should be adept at synthesizing various medical texts and applying treatments according to specific circumstances. How can one cling to partial views to cope with infinite variations? Mr. Ye's treatment of smallpox was long renowned for its miraculous efficacy. Observing his case records, he did not adhere rigidly to a single approach regarding cold, heat, purging, or tonification. For instance, when toxic fire lay deep within and qi and blood were stagnant and obstructed, he employed aromatic herbs to search out and expel the pathogen, using Zixue Dan (Purple Snow Pill). When qi stagnation and blood coagulation occurred with heavy toxicity and hidden fire, he treated it with substances such as Jiuda Huang (Rhei Radix et Rhizoma prepared with wine), Shigao (Gypsum Fibrosum), Qingpi (Aurantii Fructus Immaturus), Taoren (Persicae Semen), Jingjie (Schizonepetae Herba), Xijiao (Rhino Ceratostis - *Note: now protected/substituted*), and Zhuweixue (Porcine Tail Blood). When liver and lung toxic fire failed to diffuse, and qi and blood showed signs of scorching and burning, he used Xijiao (Rhino Ceratostis), Lingyangjiao (Saiga Tataricae Cornu), Zicao (Arnebiae Radix), Danpi (Moutan Cortex), Shigao (Gypsum Fibrosum), and Xianshengdi (Rehmanniae Radix Recens). When primordial qi could not support itself, yang deficiency led to toxin sinking, presenting with grayish-white, wet, and rotting lesions, diarrhea, vomiting, and nausea, he employed pungent, aromatic, and warming methods, following the principles of Chen Wenzhong. When qi and blood were extremely deficient, presenting with clear/thin pustule fluid, collapse, and itching, without any excess syndromes, he advocated vigorous tonification of qi and blood, using Renshen Guilu Tang (Ginseng, Deer Antler, and Angelica Decoction) or Kanli Jiji Tang (Decoction for Reuniting Kidney and Heart). For qi deficiency, Baoyuan Tang (Preserve the Origin Decoction) and Sijunzi Tang (Four Gentlemen Decoction) were paramount; for blood deficiency, Siwu Tang (Four Substances Decoction) and Buxue Tang (Tonify Blood Decoction) were essential. In cases of qi deficiency with blood heat, cooling blood herbs were added to qi-tonifying formulas; in cases of blood deficiency with qi stagnation, pungent and aromatic herbs were added to blood-tonifying formulas. When using purgative methods, one must distinguish by body region and meridians; when using tonification, one must differentiate cold, heat, dryness, and dampness. Overuse of clearing/cooling agents risks "ice-fusion" (pathogenic cold freezing the pathogen inside); bias toward heat risks depletion of body fluids. These methods reflect Mr. Ye's adoption of sages' techniques, applied according to individual presentations, truly exemplifying the skillful emulation of ancients.

Although smallpox prognosis is often judged by shape and color, internal symptoms are particularly critical. If, after eruption, the patient contracts wind-cold causing Ying and Wei levels to become stagnant, or indulges in diet leading to sluggish qi mechanism, resulting in fever, anorexia, abdominal distension, vomiting, diarrhea, and failure of pustule formation, failing to address the cause and merely adhering to cold/clearing or cloying tonification often leads to fatal outcomes. Conversely, even if the rash appears severe, if the spirit is calm, diet and excretion are normal, voice is clear, and care is appropriate, critical conditions can turn to safety. Generally, old/mature rashes with bright colors, though dense, undergo few transformations; tender rashes with dull colors, though sparse, undergo many transformations. By correlating interior and exterior, confirming the syndrome accurately, and then devising treatment, errors are avoided. Once reverse syndromes manifest fully, even ancient famous doctors cannot save the patient. Countless children die prematurely, which is deeply pitiable.

In recent years, fortunately, vaccination has become prevalent, truly reversing fate. For families with infants, vaccination can be performed after one year of age, inducing immunity with near-perfect success. This indeed supplements the deficiencies of smallpox therapy, representing the highest level of method. Natural smallpox has established methods from sages to avoid danger, while vaccination offers excellent prescriptions, making smallpox management comprehensive. (Lu Lü'an)

The emergence of smallpox stems from two sources: latent fetal toxins and guidance by external seasonal pathogens. The course (smooth vs. reverse) depends on the balance: if internal toxin is light and external pathogen is light, the rash will be sparse (Smooth Syndrome). If internal toxin is light but external pathogen is heavy, obstruction may prevent uniform eruption and filling of pustules; however, if filling occurs, the pathogen recedes, facilitating recovery (Heavy-then-Light Syndrome). If internal toxin is heavy but external pathogen is light, after filling, the toxin may not fully excrete, hindering crusting and risking toxic ulcers (Light-then-Heavy Syndrome). If both internal toxin and external pathogen are heavy, the rash will be dense, dull-colored, and difficult to resolve (Reverse Syndrome). While fetal toxin severity is easily understood, the nature of the external pathogen is obscure. The world contains Six Qi; balanced, they are harmonious; unbalanced, they generate excess/recovery cycles. Extreme imbalance creates pestilential, epidemic, or miasmic qi, plus filth from roads. Infection affects all ages. However, the specific qi causing smallpox interacts uniquely with children carrying unfired fetal toxins. It is unheard of for those who have already had smallpox to contract it again during an epidemic. Historically, no one clarified this specific qi, leading past masters to rely on biased theories—some favoring cold/purging, others warm/supporting, alternating between them. Some ignored constitution and blindly followed Fei Jianzhong's *Jiu Pian Suo Yan*, using harsh cold herbs like Dahuang, Shigao, Huanglian, etc., upon fever/rash onset. Fei's book aimed to correct overuse of heat drugs; applying it to non-biased cases causes new imbalances, endangering infants. Fortunately, ancient vaccination remains, simple and effective. Natural smallpox arises from external pathogens; vaccination is done when healthy, yielding sparse, mild cases (dozens of spots). Is this not a brilliant method to avoid danger?

Skeptics should compare natural infection vs. vaccination. In a village with 100 natural cases, even with medical care, saving 80-90 is called "peaceful." Saving only half despite effort brings no blame to doctors, only resignation to fate. In vaccination, losing 4-5 out of 100 results in punishing the vaccinator. Why trust doctors more than vaccinators? Human effort surpasses fate. Comparison decides whether to vaccinate.

Vaccination relies on good "seed material" (crusts from vaccinated children, called *Zhong Miao*). These lack epidemic toxicity and are safe. Crusts from natural infection (*Shi Miao*) contain epidemic qi; using them is equivalent to natural infection and dangerous. Even among *Zhong Miao*, selection is key: choose sparse, red, well-filled pustules with thick, shiny, round crusts (indicating sufficient qi/blood and yin/yang harmony). Store dried crusts in paper, labeled with date, in new porcelain jars, sealed tight, kept cool away from filth/heat. Viability varies by climate: North (Spring: 1 month; Winter: 40-50 days); South (Summer: 4-5 days; Spring: 20 days; Winter: 30 days). Old crusts lose potency. To obtain seeds, ask families currently vaccinating for 4-5 crusts, or arrange exchanges with honest colleagues. Bold vaccinators sometimes use robust poor children in summer to propagate seeds through several generations until autumn. Recently, some use *Shi Miao* due to shortage, causing severe/dense reactions—a fault of *Shi Miao*. Even best *Shi Miao* must pass through 4-5 smooth vaccinations to stabilize before matching *Zhong Miao*.

Technique requires caution. Use 3-4 crusts per child (6-7 for two). Soak in clean water in a cup, stir gently with little finger, drain water. Grind with willow wood pestle (4 cun long, pen-thick, smooth ends) for ~10 turns. Add 1-2 drops water if too dry; aim for dry paste consistency. Roll into cotton ball (date-seed size, rounded ends), sized to nostril. Do not make too loose (qi escapes/shrinks with mucus). Dip one end in paste, insert into nostril (left for boys, right for girls). Depth must be moderate: too deep causes discomfort, too shallow causes falling out. Prevent child from picking it out. If expelled by sneeze, reinsert immediately. Keep for 6 hours (shorter in heat, longer in cold). After removal, vaccine qi spreads through five zang organs. Fever starts day 7-8, rash appears 3 days later. This is the most stable method.

Some claim adding other herbs guides the vaccine; this is false. Post-vaccination, around day of fever, a lump (like phlegm-nodule) may appear on neck (left for boys, right for girls), indicating toxin gathering; rash will be sparse. This lump resolves after crusting. If *Shi Miao* was used, no lump appears—use this to differentiate. Occasionally, "startled smallpox" occurs: sudden convulsions, curled limbs, silence, upward gaze during fever. May last moments to hours, once or twice. Harmless. Do not disturb or call out; wait for self-resolution. No medicine needed. Reassure parents. These are secrets of contemporary vaccinators. Determining suitability requires assessing constitution and chronic illness. Care involves regulating diet, temperature, and preventing fright. Vaccinators know this well. (Zheng Wangyi)