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"Yang Dou" (imitation smallpox) refers to a situation similar to several siblings in one family: if the elder brother suffers from smallpox and it spreads to the younger brother, resulting in only a few spots appearing on the younger brother's body, this is not the typical manifestation of the younger brother's own condition, but rather what is termed "Yang Dou." If the pustules originate from the patient's own meridian positions, they are transmitted internally and cannot be viewed identically to those acquired through contact; it is erroneous for people to label such cases as "Yang Dou." However, when an elder brother infects a younger brother, an uncle infects a nephew, an elder sister infects a younger sister, or a male infects a female, the onset of these imitated cases follows the normal flow of transmission and is considered regular (Zheng); conversely, deviations from this pattern are considered irregular (Ni). Therefore, must one not distinguish carefully between true and imitated smallpox?

When sores and rashes appear in only one type of morphology, even if there are concurrent forms, detailed differentiation is essential. For instance, if pustules (purulent blisters) appear first, followed by maculopapular rashes (Zhenzi), this indicates that Spleen Earth generates Lung Metal, which is a favorable progression (Shun). If rashes appear first, followed by vesicles/pustules (Douzi), this indicates that Heart Fire generates Spleen Earth, which is also favorable. If clear fluid-filled blisters (Shuipao) appear first, followed by rashes, this indicates Liver Wood overcoming Spleen Earth, which is unfavorable (Ni). If pustules appear first, followed by vesicles/pustules, this indicates Heart Fire overcoming Lung Metal, which is unfavorable. If pustules appear first, followed by fewer blisters, this suggests that Metal and Wood are both strong and difficult to overcome; if the number of blisters is large, it is favorable. If Metal overcomes Wood, or if Wood attacks weakened Metal, it is unfavorable. If blisters appear first, followed by many vesicles/pustules, this usually indicates Fire attacking weakened Wood, which is unfavorable; however, if the number of vesicles/pustules is small, it indicates that the "child" element is weak while the "mother" element is prosperous, which is favorable. Furthermore, the appearance of pustules in spring, dark and sunken lesions in summer, vesicles in autumn, and rashes in winter are all considered unfavorable patterns. However, after the eruption of sores and rashes, there are three aspects of favorable and unfavorable indications. First, seasonal favorable/unfavorable: In spring and summer, when Yang Qi is generating and ascending, the eruption of sores and rashes is favorable; in autumn and winter, when Yang Qi is hidden and stored, their eruption is unfavorable. Second, deficiency-excess favorable/unfavorable: Constipation with the ability to eat indicates an Excess pattern, which is favorable; free defecation and urination with inability to eat indicates a Deficiency pattern, which is unfavorable. Third, exit/entry favorable/unfavorable: The outward emergence of sores and rashes is favorable; retroverted crusting (Dao Ye) or sunken/hidden lesions are unfavorable. This is a brief overview. Moreover, if rashes appear first, followed by eruptions resembling chickenpox (Shuipao), it is definitely a case of smallpox. Because the rash consumes Ying Blood (Nutritive Blood), the color appears white like chickenpox. Treatment should focus on dispersing the pathogen; once the rash dissipates and the body regenerates Ying Blood, the rash will clear and the smallpox will form naturally. One must not mistake this for chickenpox, as rashes never accompany chickenpox.