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The child's complexion is cyanotic or pale, or dark and sallow, lacking a joyful expression and spiritual luster. The eyes show more black than white, the sclera has a bluish tint, gaze is deviated, and the spirit appears dim and lifeless. There is sunken fontanelle or bulging fontanelle. Jieku (delayed closure of the fontanelles). Fontanelle not closed. Wu Ruan (five softnesses: weakness of head/neck, mouth, hands, and feet). Wu Ying (five stiffnesses: stiffness of head/neck, chest/abdomen, and limbs). Guixiong (chest protruding like a turtle shell). Beibei (spinal curvature like a turtle back). Hexi (swollen knee joints with atrophic calves, resembling crane knees). Small nostrils. Turbid breath. Voice is not resonant or prolonged; muscles are not firm, and bones are loose like dough. The body is emaciated without flesh. The skin presents with tinea, sores, or scabies. The abdomen harbors ganji (malnutrition due to spleen deficiency). Lumps are present in the neck. Vital qi has not recovered after illness. There is a history of jingxian (startle epilepsy). After weaning. Qi and blood are insufficient. Spleen and stomach are weak. Mental fatigue. The pulse is not harmonious and smooth. All the above conditions contraindicate vaccination.

Furthermore, if the parents are negligent in their conduct, ignorant of proper care, disregard taboos, distrust medical treatment, or are overly indulgent and spoiling, vaccination must absolutely be avoided.

When performing vaccination, one must carefully examine whether the child's Qi and blood are balanced, the Zang-Fu organs are in equilibrium, there is no internal injury from phlegm-heat or food stagnation, and no external invasion by the Six Excesses (pathogenic factors), before using high-quality smallpox scabs. For a one-year-old, use more than twenty grains; for three- to four-year-olds, use more than thirty grains. Place them in a clean porcelain bell, grind into fine powder using a willow wood pestle, and add three to five drops of clean water to the bell. Use warm water in spring and hot water in winter. If it dries, add a few more drops. The consistency 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 smallpox particles inside, and shape it into a date-pit form. Secure it with a red thread, leaving about one cun (inch) of tail, trimming any excess. Insert the vaccine seed into the nostril, left for boys and right for girls. Do not leave the child unattended; watch constantly. If the child touches it with their hand, stop them immediately. If sneezed out, reinsert the seed into the nose immediately without delay, lest the vital energy of the vaccine leak. After insertion, keep it for six shichen (twelve hours) before removal. In severe cold weather, leave it longer; in mild weather, remove it slightly earlier, adjusting according to circumstances. After removing the seed, its vital energy 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. After three days of appearance, the eruption completes. After three days of completion, pustules fill. After three days of fullness, fluid recedes and scabs form, completing the process.