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When a child presents with smallpox (Xia'er Douzheng), after three to five days of fever, thirty to fifty pustules emerge gradually. With no other symptoms, normal appetite and digestion, regular bowel movements, and clear spirit, the eruption follows a sequential order: emerging, filling with pus, maturing, and then receding. This is the principle of natural creation and indicates a favorable prognosis. Conversely, if the fever is severe, accompanied by facial swelling and closed eyes, sore throat and abdominal pain, choking, hoarseness, teeth grinding, cold limbs, delirium, diarrhea with undigested food and water, thirst, vomiting, distension, anorexia, chills, and dull eyes, these are all ominous signs.

The child's body is inherited from parents, and the strength of Qi and Blood depends on the prenatal endowment. The toxic heat of smallpox moves from the interior to the exterior. The exterior corresponds to the Qi level. If Qi is deficient, the lesions appear grayish-white, flat, and sunken; treatment should tonify Qi. If Qi is excess, heat is severely congested, and eruption is slow, indicating Exterior Excess; treatment should release the Exterior. The interior corresponds to the Blood level. Redness, swelling, and purplish discoloration with constipation of both stool and urine require careful medication; avoiding excessive purgation and maintaining balance is the mark of a skilled physician.

Women have physiological characteristics such as menstruation, pregnancy, and childbirth; their treatment protocols cannot be identical to those for infants. Their conditions are diverse, but I will briefly mention a few. When a woman with smallpox is filling with pus, she may encounter labor at term, or extreme smallpox heat may cause fetal death or miscarriage. She may also experience menstruation during the eruption, leading to abnormal uterine bleeding (Benglou) or hematemesis/epistaxis, resulting in Blood deficiency, which causes the smallpox lesions to deteriorate. Use Baoyuan Tang combined with Siwu Tang. If there is fetal restlessness, add fetal-calming agents. This ensures safety. How can this be treated the same as for infants?

Infants suffering from smallpox do not understand contraindications. Parents may inadvertently violate them, causing the lesions to turn black and form eschars. This transforms mild cases into severe ones, leading to critical danger and death without remedy. Such cases are common and deeply pitiable. I record these here for prevention. Avoid foul odors from fox stink, ditches, putrefaction, and filth; the bloody and musky odor of mourning widows, newlyweds, postpartum women, menstrual flow, and uterine bleeding; the smell of drunkenness, sulfur, gunpowder, and burnt hair; the damp sweat and epidemic pestilence qi of early illness; the pungent smoke from musk, bone spicules, hair, accidental fire burns; the cooking oil fumes of green onions, leeks, shallots, and garlic; and the stench of boiled lacquer and embryos. Accidental exposure to these may allow toxins to enter the interior, worsening the smallpox, with uncertain survival. To resolve this, burn frankincense, Atractylodes macrocephala, red dates, Dalbergia odorifera, and Coriandrum sativum, or spray Coriandrum sativum wine on curtains and the body. Alternatively, the mother drinks Coriandrum sativum wine and breastfeeds the infant, bringing peace. The nursing mother must also abstain from sexual desire and dietary indiscretions. Do not feed the infant chicken or duck, as these may cause blindness. Cold foods may cause hardness in the abdomen; resolve with warm medicines. Hot foods should be resolved with cool medicines, but avoid excessive cooling, as smallpox relies on warmth and nourishment. As the ancients said, neither sweating nor purging should be used at the beginning or end of the disease course.