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Before the onset of fever following variolation, smallpox-like granules suddenly appear on the infant's face, known as "Xin Miao" (Sign Seedlings), which is a precursor to the eruption of smallpox and represents the superficial manifestation of toxic qi. If the lesions are red and warm, they will typically resolve spontaneously; however, if they are red-purple, hard, and resemble fish eyes, they should be promptly punctured with a silver needle and treated externally with Er Sheng San (Two Sage Powder) to ensure safety.

(Er Sheng San) Consists of Ming Xiong Huang (Realgar) and Zi Cao (Arnebiae Radix et Rhizoma), ground together into a fine powder, mixed with oil-based Yan Zhi (Vermilion/Oil Rouge), and applied topically.

After inoculation, close relatives should be assigned to watch over the child constantly to prevent negligence by others. If treated casually with lax supervision, the child may dislike the blockage in the nose caused by the seedling and frequently pick it out, causing the leakage of seedling qi. This results in poor efficacy, leading to cases where inoculation fails to produce smallpox. However, there are also cases where the child's internal organs are robust and resistant to the seedling qi, making transmission and eruption difficult; furthermore, there are cases where deep-seated congenital toxins are latent and accumulated internally, such that even though the seedling qi has transmitted, it cannot draw out the toxin to cause eruption. In all these instances, one should wait until after the eleventh day as a standard observation period. If no eruption occurs beyond this time, re-inoculation can be performed when the weather is mild and favorable.

The standard period for variolation is seven days; fever appearing after the qi has circulated through the five zang organs is the norm. Some may take nine or eleven days to erupt, similar to slow transmission, which is not a cause for concern. If fever appears before the fifth day, at which time the seedling qi has not yet transmitted, how could the toxin erupt? This must be due to infection from epidemic seasonal pathogens occurring shortly after inoculation. These are naturally occurring smallpox cases, unrelated to the seedling qi being drawn out. Variolators must be aware of this and clarify this principle to families before inoculation.

Variolation aims to guide toxins to the exterior. It should be performed when the child is calm and free of illness, representing a smooth and auspicious procedure requiring no specific treatment. However, parents often spoil their children, leading to irregular daily routines and unregulated diet, which can cause disease. Therefore, treatment methods cannot be entirely avoided; one should follow the same protocols used for treating natural smallpox.

[Formula Song] The Three Yang meridians of the Hand run from the lateral aspect of the hand to the head; the Three Yin meridians of the Hand run from the chest interior to the hand; the Three Yang meridians of the Foot run from the head exterior to the foot; the Three Yin meridians of the Foot run along the medial aspect of the foot.

[Annotation] "The Three Yang meridians of the Hand run from the lateral aspect of the hand to the head" refers to: The Large Intestine Meridian of Hand-Yangming starts from the radial side of the index finger, ascends along the lateral aspect of the arm to the head, ending beside the nostrils; the Sanjiao Meridian of Hand-Shaoyang starts from the ulnar side of the ring finger, ascends along the middle of the lateral aspect of the arm to the head, ending anterior to the ear at the temporal artery; the Small Intestine Meridian of Hand-Taiyang starts from the ulnar side of the little finger, ascends along the lower part of the lateral aspect of the arm to the head, ending in the ear. "The Three Yin meridians of the Hand run from the chest interior to the hand" refers to: The Lung Meridian of Hand-Taiyin originates in the chest/upper abdomen, descends along the medial aspect of the arm, ending at the radial side of the thumb; the Pericardium Meridian of Hand-Jueyin originates in the chest, descends along the medial aspect of the arm, ending at the tip of the middle finger; the Heart Meridian of Hand-Shaoyin originates in the axilla, descends along the medial aspect of the arm, ending at the ulnar side of the little finger. "The Three Yang meridians of the Foot run from the head exterior to the foot" refers to: The Stomach Meridian of Foot-Yangming starts from the head, descends along the face, neck, and chest, running down the anterior aspect of the leg to the second toe; the Gallbladder Meridian of Foot-Shaoyang starts from the outer canthus, winds around the ear and vertex, descends along the lateral aspect of the body and leg to the lateral side of the fourth toe; the Bladder Meridian of Foot-Taiyang starts from the inner canthus, runs over the vertex, down the back, along the posterior aspect of the leg to the lateral side of the little toe. "The Three Yin meridians of the Foot run along the medial aspect of the foot" refers to: The Liver Meridian of Foot-Jueyin starts from the dorsal aspect of the big toe, ascends along the medial malleolus and popliteal fossa, curves around the genitalia and abdomen to the hypochondrium, ascending to below the breast; the Spleen Meridian of Foot-Taiyin starts from the medial side of the big toe, ascends along the medial aspect of the leg to the abdomen and hypochondrium; the Kidney Meridian of Foot-Shaoyin starts from the sole of the foot, ascends along the medial malleolus and heel, entering the abdomen and chest. All Yang meridians run on the exterior, and all Yin meridians run on the interior; this pattern applies to the limbs, back, and abdomen.