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To predict the auspicious or inauspicious outcome of sores and smallpox, one must deduce from the Qi and color on the face; the area of Nianshou (Age Palace) and Shanggen (Root of Nose) is particularly critical. A ruddy complexion is auspicious, while a dark or bluish hue raises suspicion.

When differentiating between variola (smallpox), exanthema, and cold damage where symptoms are similar, one may refer to the syndrome differentiation methods of the ancients. Do not lightly dismiss the use of diaphoretic agents; dispersing pathogens ensures peace only when both exterior and interior are harmonized.

Exanthema belongs to Yang and requires heat to mature; slight fever indicates a peaceful state. If the body is excessively hot like fire, detoxification should be employed to clear the urine.

The ability to eat throughout the illness is the best sign, indicating strong Spleen and Stomach function. Poor appetite suggests weak Middle Qi; if prolonged, it may transform into severe sores.

Quietness and peace are most desirable; with no pathogens in the exterior or interior, the spirit remains calm. Sudden restlessness requires careful examination; the worst scenario is loss of will leading to mental confusion.

For collapsed or hidden lesions, distinguish between excess and deficiency syndromes. Excess syndromes suit clearing and supporting therapies, while deficiency-cold syndromes require warming and tonifying, bringing joy like spring returning to a secluded valley.

Treatment varies by season; summer-heat, dampness, wind, and cold must not be neglected. Prevent conflicting pathogenic factors from interfering, which could cause chaotic transformations of the disease.

The pulse in smallpox should be peaceful; a long and clear Stomach Qi is paramount. Stringy, rapid, floating, and full pulses indicate excess conditions, while minute, deep, short, and choppy pulses indicate deficiency causes.

First Violation: Monkey Jumping Guard. Before contracting smallpox, if a child catches wind-pathogens, presenting with burning fever, headache, spontaneous sweating, and persistent cough, or if smallpox erupts after cold damage, the Yuan Qi is depleted. Urgent treatment should dispel wind and clear heat, nourish blood and Yin, and consolidate the exterior. Verse: When cold damage threatens danger, physicians must deliberate to protect the smallpox; using Chaihu decoction may lead to tragic death in infants.

Second Violation: Guanyin Brushing the Seat. If a child’s diet is unregulated and protection against summer-heat and dampness fails, Spleen and Stomach damage occurs, leading to frequent diarrhea, anorexia, and emaciation. If smallpox erupts shortly after recovery, Spleen deficiency and fluid depletion have weakened Yuan Qi. Treatment should warm and nourish the Spleen and tonify Middle Qi to allow the lesions to swell and suppurate. Verse: After diarrhea, sudden onset of smallpox indicates heavy Spleen deficiency; urgently cultivate Earth to benefit Yuan Qi, avoiding cold medicines entirely.

Third Violation: Horse Galloping on Sword Path. If dietary regulation regarding cold and heat fails, malaria ensues, consuming muscles through alternating chills and fever. If smallpox erupts shortly after recovery, Changshan and Caoguo are strictly contraindicated; instead, use Renshen, Fuling, and Baizhu to support righteous Qi. Verse: After infantile malaria, smallpox appears; depleted Yuan Qi is alarming. Remove Caoguo and Chaihu; nourishing Yin and supplementing Wei yields miraculous effects.

Fourth Violation: Single Reed Crossing the Sea. If a child has inherent frailty, presenting with fever, dry mouth/thirst, and aversion to cough, followed quickly by rash and then smallpox, this differs from the usual sequence. Smallpox before rash is "reverse"; rash before smallpox is "smooth." However, weakness with fever, thirst, and subsequent rash/smallpox eruption is dangerous. Urgently nourish Yin, clear Lung, nourish Stomach, and support Spleen. Huangqi (Astragalus) for tonifying Lung is strictly forbidden. Verse: Rash emergence indicates severe Yin deficiency; toxins invade Spleen with smallpox. Clear Metal and cultivate Earth immediately; using Huangqi will exacerbate cough.

Fifth Violation: Three Immortals Entering the Cave. If a child suffers from chronic malnutrition (Gan accumulation) with abdominal distension, visible veins, and emaciated limbs, transforming into Dingxi disease, treat smallpox as the priority. Verse: In Dingxi and Gan accumulation, focus on fully erupting the flowers. Strictly avoid draining and cold medicines like Binglang, Houpo, and Chuanlian.

Sixth Violation: Upside-down Silver Vase. If a child has wind-heat causing intermittent fever from head to body, with widespread Danliu (erysipelas-like swelling), and smallpox erupts before full recovery, use Xijiao, Dihuang, and Danpi to clear the Liver and Heart meridians. Verse: Danliu unresolved with smallpox appearance involves Liver and Heart. Beware of red roots encircling; resolve inflammation and remove toxins for clear lesions.

Seventh Violation: Frost Bridge Impressions. If a child has a burning red face, staring eyes, limb convulsions, frequent惊厥 (convulsions), dry mouth, and delirium, with smallpox appearing days after recovery, this differs from the normal sequence of惊 before smallpox. Here, the惊 is severe due to Heart involvement. Treat smallpox primarily; sedating Heart and cooling Zang organs is contraindicated. Verse: After convulsions subside, smallpox follows. Avoid Zhusha and Jinshi. If惊 persists, promote eruption and further tonify.

Eighth Violation: Lotus Pond Seeping Water. If a child has fever, spontaneous sweating, hemoptysis, epistaxis, or hematuria, with smallpox appearing days later, this indicates Heart organ failure causing reckless blood movement. Clear Heart and suppress Fire; do not recklessly use cold/cooling medicines. Verse: All bleeding stems from Heat invading Heart; clearing Heart and suppressing Fire returns blood to Ying. Do not lightly use cold formulas, lest regret be deep.

Ninth Violation: Stone Drum Yawning. Before smallpox, if a child has fever, anorexia, abdominal distension, eyelid edema, and restless sleep, with smallpox appearing soon, treat by tonifying Spleen and regulating Qi. Verse: Abdominal distension and lack of appetite indicate difficult Spleen Qi/Yin deficiency. Quickly tonify Spleen and regulate Qi/Blood; promoting release brings natural peace.

Tenth Violation: Red Marsh Planting Lotus. If a child has aversion to heat, continuous sweating, blurred vision, yawning, and crying, with smallpox appearing as symptoms resolve, treat by arresting sweating using Huangqi boiled in human milk, administered frequently. Assist with formulas regulating Ying and supplementing Wei. Verse: Sweating and heat loss deplete Yuan Qi; smallpox affecting Heart/Liver is ten parts fatal. Urgently tonify Heart/Liver and arrest sweating; smallpox will heal naturally like boiling cauldrons.

Eleventh Violation: Rock Head Running Horse. If a child suffers trauma/falls, with smallpox appearing within days, treat by nourishing and invigorating blood, combined with supporting Spleen. Verse: During unresolved trauma/shock, good flowers emerge. Calm meridians, invigorate blood, regulate Spleen pulse, and enjoy unique blossoms.

Twelfth Violation: Hunting Deer Losing Sheep. If a child has tidal fever, abdominal masses accumulating over time, weakness, sallow complexion, and smallpox eruption, do not treat the masses directly. Verse: When disease-masses bloom, tonify Yuan Qi. Support Spleen/Stomech without delay. Prioritize treating smallpox to root the foundation; fear not incomplete life of the flower.

Thirteenth Violation: Pushing Cart Trapped in Snow. If a child inherits maternal fetal toxin, suffering from Yangmei Guangchuang (syphilis-like sore) with intermittent chills/fever, and smallpox erupts before resolution, how to treat? Verse: Erupting smallpox while evil sores persist; use Shengma without error. Do not rely on Lianqiao or other detoxifiers; mistaken fumigation/rubbing causes harm.

Fourteenth Violation: Frost Chasing Wutong Tree. If a child has burning fever, frequent vomiting, inability to eat, and smallpox appears despite Qi-regulating attempts, how to treat? Verse: Vomiting and panic indicate Stomach disharmony; suddenly flowers/smallpox grind together. Must soothe Stomach and promote release; success ensures no harm.

Fifteenth Violation: Tired Dragon Bringing Rain. If improper diet damages Spleen/Stomach, causing flaccid limbs, fever, aversion to cold, and smallpox eruption, how to treat? Verse: Child injured by diet meets disaster; smallpox comes from Yangming Stomach. Slightly digest internally and tonify Stomach; promoting release allows flowers to bloom.

Sixteenth Violation: Autumn Cicada Weeping Dew. Before smallpox, if damp-heat causes red-white dysentery, and smallpox erupts before resolution, how to treat? Verse: Dysentery/smallpox treatment clears damp-heat, cultivates Earth, harmonizes Qi/Blood. Promote smallpox eruption to nourish flowers; regulating foundation extinguishes disaster.

Seventeenth Violation: Frozen Scales Emerging from Valley. If hand/foot injury from blades causes alternating chills/fever and smallpox eruption, how to treat? Verse: Unhealed metal wounds present with smallpox. Invigorate blood and open stagnation. Promote eruption for surface exposure; supporting the tripod ensures peace.

Eighteenth Violation: Fish Boat in Waves. If a child suffers frequent convulsions or wind-phlegm epilepsy, and smallpox appears early, how to treat? Verse: Wind-phlegm suffers smallpox催促. Focus on cultivating the flower fence. Fill with pus, blossom by blossom; fear not wind/rain instability.

Different books list various names, collectively termed the Eighteen Violations Before Smallpox, focusing primarily on nurturing the eruption. If these violations occur after smallpox, the priority shifts exclusively to tonifying Yuan Qi.