种痘发热以前，小儿面部上忽出颗粒似痘，名曰信苗，此痘之将发毒瓦斯之标也。色
红而软，听之自消。若红紫坚硬，有如鱼目者，急以银针挑破，上以二圣散则无虞。
二圣散
明雄黄 紫草（各等分）
共碾为细末，用油胭脂调上。
下苗后，宜令亲切之人左右看守，恐他人用心之不慎也。若视为泛常，看守疏忽，恐
小儿恶其苗塞鼻中，不时捏出，使苗气一泄，种多不验。所以种而不发者亦有之也。然或
小儿五内壮实，不受苗气，艰于传进，不发者亦有之。更有胎毒深邃，潜藏内蓄，虽苗
气传至，不能引出，不发者亦有之。俱当俟逾十一日为度，过此不发，然后察天时和顺，
再为补种之亦可。
种痘以七日为期。五脏传遍始发热者，常也。或有至九日、十一日而发者，此传送迟
慢之故，亦无足虑。若发热于五日以前，此时苗气尚未传至，其毒何由而发？必因种后
适逢天行时气，小儿感染而成。是乃自出之痘，非关苗气出引者。种痘者不可不知，要
当于未种之时，预为申明其说焉。
种痘乃引毒达表，乘儿安宁无病之时，事属顺吉，又何言治。然恐痘家过于溺爱，起
居不谨，饮食不节，此病所由生也，故治法亦所不免。当悉照治正痘之法，治之可也。
Before the fever following variolation, smallpox-like granules suddenly appear on the child's face, known as "Xin Miao" (Sign of Variolation), which is the external sign that the smallpox toxin is about to manifest. If the color is red and soft, it may be left to resolve spontaneously. If the color is red-purple and hard, resembling fish eyes, it should be promptly pricked with a silver needle and covered with Er Sheng San (Two Sage Powder) to ensure safety.
Er Sheng San (Two Sage Powder)
Ming Xionghuang (Real Realgar) and Zicao (Arnebiae Radix et Rhizoma) in equal parts.
Grind together into a fine powder, mix with oil-based rouge, and apply topically.
After inoculation, close relatives should watch over the child closely to prevent careless handling by others. If treated casually or if supervision is negligent, the child might dislike the blockage in the nose caused by the inoculum and frequently pinch it out, causing the "Miao Qi" (Vaccine Spirit/Virulence) to dissipate, resulting in failed inoculation. Thus, cases where inoculation does not take place do occur. However, some children have strong internal organs (Zang-Fu) and resist the Miao Qi, making transmission difficult, leading to no eruption; this also happens. Furthermore, deep-seated fetal toxins (Tai Du) hidden and accumulated internally may prevent the Miao Qi from drawing out the toxin even if transmitted, resulting in no eruption; this too occurs. In all such cases, one should wait until eleven days have passed. If no eruption occurs after this period, and provided the heavenly timing (seasonal climate) is harmonious, a supplementary inoculation may be performed.
The standard period for variolation is seven days. Fever appearing only after the toxin has circulated through the five Zang organs is the normal course. Eruption occurring on the ninth or eleventh day is due to slow transmission and is not a cause for concern. However, fever appearing before the fifth day implies that the Miao Qi has not yet reached its destination; how could the toxin erupt? This must be because the child contracted an epidemic pathogen (Tian Xing Shi Qi) shortly after inoculation. These are naturally occurring smallpox cases, unrelated to the vaccine spirit. Those performing variolation must understand this and clarify these principles beforehand, prior to inoculation.
Variolation aims to guide the toxin to the exterior. It is performed when the child is peaceful and free from illness, representing a smooth and auspicious procedure, so treatment is generally unnecessary. However, fearing that parents may overly dote on the child, leading to irregular daily routines and unregulated diet—which are causes of disease—treatment cannot be entirely avoided. The treatment should follow the methods used for treating natural smallpox (Zheng Dou).