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When a child's complexion is cyanotic and pale, or dark/blackish with sallow atrophy, lacking joyous expression and vitality; when the eyes show more black than white, the sclera has a bluish tint, gaze is slanted or dim and spiritless; when the fontanelle is sunken or bulging, there is delayed closure of the fontanelle (Jie Lu), the five softnesses (Wu Ruan - weakness of head, neck, mouth, hands, feet, and muscles), five rigidity/deformities (Wu Di), turtle chest (Gu Xiong), turtle back (Gu Bei), crane knee (He Xi); when nostrils are small, breath is turbid, voice is not resonant or long, muscles are lax, bones are loose like dough, body is emaciated without gluteal flesh, skin has scrofula or scabies, abdomen has infantile malnutrition (Gan Ji), neck has tubercles, post-illness Yuan Qi has not recovered, there is a history of fright convulsions or epilepsy, after weaning Qi and Blood are insufficient, Spleen and Stomach are weak, spirit is fatigued, pulse is unharmonious. All the above conditions contraindicate vaccination.

For children whose parents are negligent in conduct, unaware of proper care, disregard taboos, distrust medicine, or are overly doting and spoiling, vaccination must absolutely be avoided.

At the time of vaccination, one must carefully examine whether the child's Qi and Blood are harmonious, Zang-Fu organs are balanced, internally free from damage by phlegm-heat or food retention, and externally free from invasion by the Six Exogenous Pathogens (Liu Yin). Only then can high-quality variolae crusts be used for inoculation. For a one-year-old, use over twenty grains; for three to four years old, use over thirty grains. Place them in a clean porcelain mortar, grind into fine powder using a willow wood pestle. Add three to five drops of pure water to the mortar. In warm spring weather, use room temperature water; in cold winter weather, use warm/hot water. If it dries out, add a few more drops. The mixture should always be uniform, neither too dry nor too wet. Take a small amount of new cotton, spread it into an extremely thin sheet, wrap the prepared variolae powder inside, and pinch it into a date-pit shape. Secure it with a red thread, leaving about one cun of thread length; if longer, trim it off. Insert the seed into the nostril: left nostril for boys, right nostril for girls. Do not leave the child unattended; watch constantly. If the child fiddles with it using fingers, stop them immediately. If sneezed out, reinsert the seed into the nose immediately without delay, lest the efficacy of the seed be lost. After inserting the seed, keep it in place for six shichen (twelve hours) before removal. If the weather is severely cold, leave it for a bit longer; if the season is mild and warm, remove it a few ke (quarters of an hour) earlier. This requires discretion based on the situation. After removing the variolae seed, its qi gradually enters the body and spreads through the Five Zang Organs. Fever begins on the seventh day. After three days of fever, the rash appears. Three days after appearance, the lesions fully erupt. Three days after full eruption, they begin to suppurate (fill with pus). Three days after being fully filled, the fluid recedes and scabs form. The great task is accomplished.