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It is traditionally believed that smallpox with few lesions, consisting of only dozens or over a hundred spots, where the base and crown are round and distinct, are called "Zhuangyuan Smallpox" (Scholar Champion Smallpox), implying that medication may not be necessary. However, I hold that even in such cases, during the third or fourth day of onset, one dose of Xinliang Jiedu Yao (Acrid-Cool Detoxifying Medicine) must be administered; excessive dosage is unnecessary. By the seventh or eighth day, one dose of Ganwen Tuojiang Yao (Sweet-Warm Supporting Pustule Medicine) should be used, not exceeding two doses in total, ensuring that the pustules fill adequately. Why is this so? I have witnessed cases of sparse smallpox where the pus formation was insufficient. After scabbing, patients developed eye diseases, with toxic heat flowing into the Heart and Liver meridians. Some died months or half a year later due to restlessness and irritability, becoming incurable.

Regarding the time limits for smallpox progression, contemporary physicians often believe that treatment is successful once scabs form after twelve days. However, ancient traditions state that all aspects of smallpox management extend within one hundred days. I had a niece who contracted smallpox in March or April. Her pus formation was insufficient, and within one hundred days, she developed severe eye disease, with her eyeballs protruding from the sockets. She survived until February of the following year before passing away. At the time of death, her face displayed five colors: alternating between cyan, red, yellow, white, and black. This indicated that toxic vapors had traversed all five Zang organs, and she expired after three days and nights. Reflecting on this now, it remains deeply tragic. Can physicians afford to be careless? Twelve days is the limit for scabbing, yet even this limit varies. For children born after the age of three, twelve days can serve as the standard. For those born after their first birthday, the limit is only nine days. For infants under one year old, the limit is merely seven days.

In recent times, people's hearts have lost their simplicity, favoring superficial decoration and handling matters hastily. When the top of the pimple first becomes turbid, they claim the pus is sufficient. The patient's family, unaware of the truth, relies solely on the physician. If pus is insufficient and toxic eruption occurs, it might still be treatable. However, if it erupts in hidden areas like joints, it can lead to death or disability. Patients suffering from eye complications and restlessness rarely survive; even if they do not die, they will go blind. Having treated many cases, I consider the color of the pus to be roughly that of a soybean. In cases with many lesions, if the legs and feet remain relatively clear, it is acceptable. Throughout my life, the smallpox patients I treated left no sequelae afterward. There were no other tricks involved; it was simply because the pus formation was adequate. The current malpractices can be summarized in three points: First, overuse of cold and cool medicines before the seventh day, followed by a failure to use tonifying and supporting methods afterwards, coupled with a fear of warm medicines akin to fearing tigers, sometimes even relying solely on Dahuang (Rhei Radix et Rhizoma). This reflects imprecise prescription practices. Second, an inability to recognize the color of the pus, reflecting poor diagnostic observation. Third, a deliberate intent to deceive for appearance's sake, reflecting a lack of compassion. I dare not and cannot engage in deception. My speech is too blunt, and my heart too compassionate, causing me to clash with worldly norms. Witnessing children suffer helplessly without being able to save them is truly mournful. I wrote this treatise to vigorously correct these contemporary evils, drawing from decades of clinical experience. I observe that post-smallpox conditions are a hundred times more difficult to manage than pre-smallpox conditions. Before smallpox, there is pus to rise; after smallpox, there is no pus to circulate. Pre-smallpox pathology moves from interior to exterior, which is favorable (Shun); post-smallpox pathology sinks from exterior to interior, which is unfavorable (Ni). If toxic heat sinks into the collaterals, it can still be treated. If it sinks into the Zang organs and damages their true Qi, historical records show no effective cure exists. Physicians can face the families of those who die from unfavorable smallpox patterns, but how can they face the families of those who die due to residual toxins caused by imprecise treatment? Readers of this treatise should reflect on the importance of caution from the very beginning.