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First Violation: Ape Jumping through Locks. Whenever a child, before developing smallpox, first contracts wind-pathogens, the body feels hot as if branded by fire, accompanied by headache and spontaneous sweating, with incessant coughing; or if smallpox erupts immediately after an attack of cold damage (Shanghan), the primordial qi is extremely depleted. Urgent treatment should focus on dispersing wind and clearing heat, nourishing blood and yin, regulating primordial qi, and consolidating the exterior. The verse states: Once contracted cold damage, the condition becomes critical; physicians must deliberate carefully to avoid harming the smallpox eruption. If Chaihu Decoction is used, the infant may die tragically due to internalized toxins, a sorrowful outcome.

Second Violation: Guanyin Brushing Acne. Whenever a child’s diet is unregulated, and summer-dampness pathogens are not properly guarded against, the spleen and stomach are frequently damaged. This leads to diarrhea, loss of appetite, and emaciation of the limbs. If smallpox erupts shortly after recovery, it indicates spleen deficiency and fluid depletion, with primordial qi being weak. Treatment should warm and nourish the spleen's primordial qi and tonify middle-jiao qi, so that the smallpox pustules can swell, suppurate, and firm up. The verse states: When smallpox symptoms suddenly appear, spleen deficiency and primordial depletion cause a heavy condition. Urgently cultivate earth (spleen) to benefit primordial qi; do not invade with even a grain of cold medicines.

Third Violation: Horse Galloping on Sword Path. Whenever a child’s diet lacks regulation regarding cold and heat, leading to malaria lingering in the body, alternating chills and fever consuming muscles, and gradual emaciation, if smallpox erupts shortly after recovery, Changshan (Rhizoma Coptidis) and Caoguo (Fructus Tsaoko) must absolutely not be used. Only Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) should be used to support righteous qi. The verse states: After infantile malaria, smallpox welcomes the patient; primordial qi dispersion is alarming. Remove Caoguo and Chaihu completely; nourishing yin and supplementing defense yields miraculous effects.

Fourth Violation: One Reed Crossing the Sea. Whenever a child has a frail constitution, develops high fever, dry thirst, and aversion to coughing, and if smallpox erupts shortly after rash eruption, this differs from the normal sequence of rash preceding smallpox. Normally, smallpox preceding rash is termed "counter-flow" (Ni), while rash preceding smallpox is termed "smooth" (Shun). However, in this case, with weak body, fever, aversion to cough, dry thirst, followed by rash and then numerous smallpox lesions, the situation is perilous. Urgent treatment must nourish yin, clear lung heat, nourish the stomach, and support the spleen. Huangqi (Astragalus) formulas for tonifying the lung must be strictly prohibited. The verse states: When rash emerges, Taiyin deficiency exists; smallpox toxins lodge in the spleen. Urgently clear metal (lung) and cultivate earth (spleen); using Huangqi will hasten the cough.

Fifth Violation: Three Immortals Entering the Cave. Whenever a child suffers from chronic Gan accumulation (malnutrition/parasitic disease) with a distended abdomen and visible veins, emaciated limbs, progressing to Dingxi Gan (severe malnutrition), and smallpox suddenly erupts, treatment should prioritize managing the smallpox. The verse states: Dingxi Gan accumulation intersects with smallpox; allow the flowers (pustules) to fully emerge. Strictly prohibit draining and cold medicines such as Binglang (Areca Seed), Houpo (Magnolia Bark), and Chuanlian (Coptis Rhizome).

Sixth Violation: Inverted Silver Vase. Whenever wind-heat pathogens manifest in the couli (interstices), causing high fever from head to body, and Danliu (erysipelas-like tumors) appear everywhere, if smallpox erupts before full recovery, use Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Shengdi (Rehmannia Root), and Danpi (Moutan Cortex) to clear heat from the Liver and Heart meridians. The verse states: Danliu unresolved, smallpox forms appear on the body; this belongs to the Liver and Heart meridians. Most feared is the red root encircling; clearing inflammation and removing toxins clarifies the smallpox.

Seventh Violation: Bridge Frost Imprint. Whenever a child’s face is red as if branded, eyes staring straight, limbs twitching, frequent convulsions, dry mouth, and delirious speech, and if smallpox appears within a few days of recovery, this differs from the usual sequence of convulsion preceding smallpox. Since smallpox-induced fright relates to the Heart meridian, mild fright usually subsides when smallpox appears. Here, the fright is severe. Treatment should prioritize smallpox management; sedating-heart and cooling-viscera formulas must not be administered. The verse states: After new recovery from convulsions, smallpox follows; do not pursue Zhusha (Cinnabar) and Jinshi (mineral drugs). If fright persists without rest, continue promoting eruption and nurturing.

Eighth Violation: Lotus Pond Seeping Water. Whenever a child has fever, spontaneous sweating, hemoptysis, epistaxis, or hematuria, and if smallpox lesions appear within a few days of recovery, this indicates Heart organ failure leading to reckless blood movement. Treatment should clear the Heart and suppress fire; cold-cooling medicines must never be used recklessly. The verse states: All bleeding stems from heat invading the Heart; clearing the Heart and suppressing fire returns blood to the Ying level. Do not lightly use cold-cooling agents; regret over wilted flowers will be deep.

Ninth Violation: Stone Drum Yin Resonance. Before smallpox eruption, if a child has feverish heat, poor appetite, abdominal distension, puffy eyelids, and restless sleep, and smallpox appears within a few days, treatment should tonify the spleen and regulate qi. The verse states: Abdominal distension and loss of appetite indicate qi obstruction and spleen deficiency, making smallpox difficult. Quickly tonify the spleen and regulate qi and blood; adding exterior-releasing measures ensures natural peace.

Tenth Violation: Red Marsh Planting Lotuses. If a child experiences aversion to heat, incessant spontaneous sweating, blurred vision, yawning, and crying, and smallpox erupts immediately after symptom resolution, treatment should stop sweating using Huangqi (Astragalus) decocted in human milk for frequent drinking, combined with formulas regulating Ying and Wei. The verse states: Sweating profusely and aversion to heat deplete primordial qi; smallpox affecting Heart and Liver leaves less than ten percent chance of survival. Urgently tonify Heart and Liver and stop sweating; smallpox filling like a tripod will naturally heal.

Eleventh Violation: Cliffside Galloping Horses. If smallpox appears within a few days of traumatic injury, treatment should regulate and invigorate blood while supporting the spleen. The verse states: During unresolved trauma and fright injury, good flower branches emerge from within. Calm meridians, invigorate blood, and regulate spleen pulse; naturally, all flowers bloom wonderfully.

Twelfth Violation: Hunting Deer, Losing Sheep. If a child has tidal fevers, abdominal masses accumulating over time, emaciation, sallow complexion, and weakness, and smallpox erupts, treating the mass is inappropriate. The verse states: When illness-masses bloom like flowers, tonify primordial qi. Support spleen and stomach without delay; especially treat smallpox to cultivate the root. Why fear the flower's life incomplete?

Thirteenth Violation: Pushing Cart into Snow. If a child inherits parental fetal toxins, suffers from Yangmei Guangchuang (chancre/syphilis-like sores), intermittent chills and fever, and smallpox erupts before recovery, how to treat? The verse states: When malignant sores are unresolved and variola erupts, Shengma (Cimicifuga) medicine is accurate. Do not rely on Lianqiao (Forsythia) and other detoxifying herbs; mistakenly applying fumigation or ointments causes error.

Fourteenth Violation: Frost Chasing Wutong Trees. If a child’s body is hot as if branded, with frequent vomiting, inability to eat, and smallpox appears amidst seasonal pathogens, how to treat? The verse states: Vomiting and panic indicate stomach disharmony; suddenly seeing flower-smallpox grinding each other. Must soothe the stomach and release the exterior; success will ensure no harm.

Fifteenth Violation: Tired Dragon Bringing Rain. If improper diet damages spleen and stomach, causing limbs to refuse movement, fever, and aversion to cold, and smallpox appears, how to treat? The verse states: Infant injured by diet meets disaster; smallpox comes from Yangming Stomach. Slightly resolve interior accumulation and tonify stomach; adding exterior release lets flowers bloom naturally.

Sixteenth Violation: Autumn Cicada Weeping Dew. Before smallpox eruption, if damp-heat pathogens cause dysentery (red and white stools), and smallpox appears before dysentery resolves, how to treat? The verse states: Dysentery-smallpox naturally requires draining damp-heat; further cultivate earth and harmonize qi and blood. Also, release smallpox to nourish flowers again; adjusting the root extinguishes disaster.

Seventeenth Violation: Frozen Scales Emerging from Valley. If accidental blade injury to hands and feet causes alternating chills and fever, and smallpox appears, how to treat? The verse states: Metal wounds unresolved, smallpox presents; invigorate blood and open stagnation. Further promote eruption and release exterior; supporting the tripod ensures peace.

Eighteenth Violation: Fishing Boat in Waves. If a child frequently suffers convulsions or wind-phlegm epilepsy, and smallpox appears shortly after, how to treat? The verse states: Wind-epilepsy suffers again from smallpox urging; focus on cultivating the flower fence. Fill with pus, let flowers bloom; do not fear wind and rain causing instability.

Although books record different names, the eighteen violations before smallpox all emphasize nurturing the flowers (smallpox eruption). If these eighteen violations occur after smallpox eruption, the priority shifts entirely to tonifying primordial qi.