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Among the medical methods lost today, none is more so than those for variola (smallpox). The origin of smallpox lies hidden within the Zang-Fu organs, bones, and vessels, while its manifestation is governed by celestial timing. What is meant by "rooted in the Zang-Fu organs, bones, and vessels" is that at the initial stage of human conception, when Yin and Yang Qi interact to form the body, there must be some dregs that fail to fully integrate due to the movement of Fire. These dregs lie dormant within the Zang-Fu organs, bones, and vessels; this is the root source of smallpox. However, without external感召 (induction), these latent pathogens will not emerge. When the cold, heat, Yin, and Yang Qi of heaven and earth accumulate into malevolent Qi, and resonate with the Zang-Fu and Qi-Blood of the human body, the toxicity within them will then vent outward. This is what is meant by "manifesting according to celestial timing."

Furthermore, celestial timing varies according to the Five Movements and Six Qi, and differs in the relationships between root and branch, excess and deficiency. Since individual constitution and endowment differ, and the induction and activation vary with time, treatment methods must comprehend the principles of natural creation to provide remediation. This is an extremely refined and subtle art. Why, then, attack it with cold-cooling herbs and劫夺 (rob/capture) it with toxic substances? It is true that the root of smallpox is essentially Fire. However, as stated in the *Nei Jing* (Inner Canon): "When Fire is constrained, disperse it." If one encounters hot weather where Fire is abundant and easily manifests, clearing heat and resolving toxicity is indeed appropriate. But during winter and spring, if the Qi is constrained by Cold, the eruption will not rise; if it rises but Jing-Blood is insufficient, no pustular fluid will form; if there is fluid but Jing-Blood cannot sustain it, scabbing will not occur. Therefore, methods of warming and dispersing, lifting and supporting, and tonifying and nourishing are indispensable. How can one indiscriminately use cold-cooling herbs? As for using toxic substances such as earthworms (Pheretima), silkworm pupae (Bombyx Batryticatus), and live scorpions (Scorpio), the harm caused is particularly severe. The principle of "using toxicity to combat toxicity" applies only when toxic vapors have collapsed inward and cannot be lifted out temporarily, necessitating their strength to penetrate and erupt the disease. This scenario occurs in critical, life-threatening cases, perhaps one in a thousand. Yet, treating it as a common medication means that those without inherent toxicity inadvertently increase their toxicity. Patients do not resent death because the physician claims to know the time of death. Little do they know that taking such physicians' medicines leads inevitably to death; this is not high insight, but cunning in prescription. Thus, survival or death from smallpox depends entirely on Qi and Blood. When clearing Fire and resolving toxicity is indicated, do so; when tonifying Qi and Blood is indicated, use warming support and nourishment, and you will rarely fail. Alas! These erroneous theories spread since the late Ming Dynasty and remain prevalent today. Physicians simply prescribe a few cold-natured herbs daily according to a fixed schedule, and if ineffective, follow up with toxic substances. To apply such rigid and crude methods to a disease of extreme variability and subtlety leads many to believe smallpox treatment is easy, unaware that it kills the most people.

Appendix: On Variolation
The method of variolation was transmitted by immortals. It possesses nine advantages: First, while most things desire aggregation, smallpox does not; forcibly inducing eruption before it naturally arises prevents toxin aggregation. Second, while most things desire expansion, smallpox desires scarcity; forcibly inducing eruption ensures scarcity. Third, while most things desire growth, smallpox desires smallness; forcibly inducing eruption ensures small lesions. Fourth, it avoids infection by the malevolent Qi of epidemic smallpox. Fifth, it allows selection of days with gentle and harmonious heaven-earth Qi. Sixth, it allows selection of times when the child has no other illnesses. Seventh, the vaccine material is taken from benign seeds that produce non-toxic eruptions. Eighth, in natural smallpox, pus must reach full maturity (ten parts) to prevent toxin collapse; in variolation, pus reaching five parts is harmless. Ninth, natural smallpox requires twelve days to scab, sometimes extending to a month; variolation results in regression and scabbing within nine days. Those who die after variolation deeply regret it, not realizing that even if the disease had erupted naturally, death would have been inevitable, so there is no need for regret. Regarding dangerous eruptions post-variolation or the generation of toxic sores, this is due to the physician's inability to medicate correctly. If the person performing variolation also understands basic smallpox treatment methods, the outcome would be perfect.