小儿神气末充实，触恶何能自主持，目闭面青惊闷乱，苏合皂角功效奇。
[注]
小儿神气末充，一为邪恶所触，何能主持，自然神魂离舍，
目闭面青，闷乱不省人事，内以四合香丸除其邪，
外以皂角末开通其闭，嚏出则气通而苏矣。
(苏合香丸) 方见肛门内合。
%
上古无痘性淳朴，中古有痘情欲恣，痘禀胎元出不再，毒之深浅重轻识，
天疮之名因天禀，疮形如豆痘名居，塞北不出寒胜热，毒发必自待天时。
[注]
上古之人无出痘者，天性淳朴也，
中古之人有出痘者，情欲渐炽也，古人谓痘禀胎毒此定论也，
惟禀于胎元，故一出不再出也，
毒有浅深，故出有轻重也，
名为天疮者，因毒禀于先天也，
名为痘疮者，因疮形如豆也，
其毒伏于形中而塞化不出者，以其气多寒凉，
鲜邪阳火旺之气以触发其毒，故伏藏于内而不出也，
中土之人必出者，以其气多温热，一触邪阳火旺之气，毒随内发而即出也，
此皆医所当识者也。
%
欲识小儿出痘形，类是伤寒发热惊，气粗眼目廷中指冷，耳尻不热耳筋红。
[注]
痘证初起，见证大扺与伤寒相似，
其候身体发热，不时惊悸，口鼻气粗，两眼发□，惟中指独冷，耳尻不热，
耳后有红筋，皆为出痘之形证也。
%
The child's Shen Qi (Spirit and Vital Energy) is not yet fully consolidated; how can they maintain autonomy when touched by malignant pathogens? Symptoms include closed eyes, cyanotic complexion, fright, and mental confusion. Suhe Wan (Styrax Pill) and Zaojiao (Gleditsia Sinensis Fruit) exhibit miraculous efficacy.
[Note]
The child's Shen Qi is not yet robust. Once touched by evil pathogens, how can they govern the body? Naturally, the Hun and Po (ethereal and corporeal souls) will leave their residence.
Symptoms manifest as closed eyes, cyanotic complexion, chest oppression, restlessness, and loss of consciousness. Internally, Sihe Xiang Wan (Four-Combination Fragrant Pill) is used to eliminate pathogens.
Externally, Zaojiao powder (Gleditsia sinensis fruit powder) is applied to open blockages. Sneezing results in the flow of Qi and recovery of consciousness.
(Suhe Wan) See the section on Anus Internal Combination for the formula.
In ancient times, there were no cases of smallpox due to the simplicity of human nature. In middle antiquity, smallpox appeared due to unrestrained desires. Smallpox toxins are inherited from the fetal origin and do not recur after the first eruption. One must recognize the depth and severity of the toxin.
The name "Tian Chuang" (Heavenly Sore) derives from congenital endowment. The name "Dou" (Pustule) is given because the sore resembles a bean. In the northern regions, smallpox does not occur because cold overcomes heat; toxin eruptions must await favorable timing.
[Note]
People in ancient times did not suffer from smallpox due to their simple and unadulterated nature.
People in middle antiquity suffered from smallpox due to gradually intensifying desires. The ancient saying that smallpox is derived from fetal toxin is a definitive conclusion.
Because it is inherited from the fetal origin, it occurs only once in a lifetime.
Because the toxin has varying depths, the eruption presents with varying severity.
It is called "Tian Chuang" (Heavenly Sore) because the toxin is endowed by the Pre-Heaven (congenital essence).
It is called "Dou Chuang" (Smallpox Sore) because the sore shape resembles a bean.
When the toxin remains latent within the form and fails to transform and emerge, it is because the body's Qi is predominantly cold and cool.
Without the triggering Qi of pathogenic Yang and excessive fire, the toxin remains hidden internally and does not erupt.
People in the Central Plains will inevitably suffer from smallpox because their Qi is predominantly warm and hot. Upon contact with the Qi of pathogenic Yang and excessive fire, the toxin erupts internally immediately.
These are all matters that physicians must recognize.
To identify the morphology of pediatric smallpox eruption, the symptoms resemble Shaoyang disease or Taiyang disease with fever and fright. Signs include coarse breathing, staring eyes, coldness of the middle finger, lack of heat in the ears and sacrum, and redness of the ear meridians.
[Note]
At the onset of smallpox, the manifestations largely resemble those of Shanghan (Cold Damage) disease.
The presentation includes bodily fever, frequent palpitations/fright, coarse breathing through the mouth and nose, staring eyes, coldness isolated to the middle finger, lack of heat in the ears and sacrum,
and red meridians behind the ears. These are all precursory signs of smallpox eruption.