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In ancient times, people possessed simple and pure natures and did not suffer from smallpox; in middle antiquity, desires became unrestrained, leading to the emergence of smallpox. Smallpox is endowed by the fetal origin (Taiyuan), thus occurring only once in a lifetime; its severity can be identified by assessing the depth and lightness of the pathogenic toxin.

The name "Tian Chuang" (Heavenly Sore) derives from the toxin being endowed by the pre-heavenly constitution (Tianbing). It is called "Dou" (Pox) because the sore resembles a bean. In the northern regions beyond the Great Wall, smallpox does not manifest because cold dominates over heat; the toxin remains latent and must await favorable climatic conditions (Heavenly Time) to erupt.

[Note] People in ancient times did not contract smallpox due to their simple and pure nature. Those in middle antiquity contracted it as desires gradually intensified. The ancients stated that smallpox stems from fetal toxin, which is a definitive conclusion. Because it is endowed by the fetal origin, it occurs only once. Since toxins vary in depth, the manifestation varies in severity. Named "Tian Chuang" because the toxin is endowed by the pre-heavenly source. Named "Dou Chuang" because the sore shape resembles a bean. The toxin lies latent within the body; in the north, where the climate is predominantly cold and lacks the qi of evil yang and excessive fire to trigger the toxin, it remains hidden internally without erupting. In the central plains, people inevitably develop smallpox because the climate is warm and hot; upon contact with the qi of evil yang and excessive fire, the toxin erupts immediately along with the internal qi. These are matters physicians must recognize.

To identify the morphology of pediatric smallpox eruption, symptoms resemble Taiyang disease (Shanghan), presenting with fever,惊悸 (palpitations/fright), coarse breathing, red eyes, coldness of the middle finger alone, non-heat in the ears and sacrum, and red veins behind the ears.

[Note] At the onset of smallpox, observed symptoms largely resemble those of Taiyang disease. Manifestations include bodily fever, intermittent palpitations and fright, coarse respiration through mouth and nose, redness of both eyes, isolated coldness of the middle finger, lack of heat in the ears and sacrum, and red veins behind the ears; all these constitute the morphological signs of smallpox eruption.

The primary syndromes and morphologies associated with smallpox affecting the Five Zang Organs are as follows: yawning and sudden chest oppression indicate the Liver Meridian; coughing with phlegm, sneezing, tearing, and runny nose indicate the Lung Meridian; palpitations, irritability, and reddish complexion indicate the Heart Meridian; drowsiness, spontaneous diarrhea, and limb heat indicate the Spleen Meridian; coolness of both ears and sacrum indicates the Kidney Meridian. The shape of Liver smallpox is a water blister, green and small; the shape of Lung smallpox is a pus blister, white and large; the shape of Heart smallpox is red and small; the shape of Spleen smallpox is yellowish and large. Regarding the Kidney Meridian, no specific signs should ideally appear; if Water fails to overcome Fire and the pox turns black, this is an inauspicious omen.

[Note] The toxin of smallpox lies latent within the Five Zang Organs; thus, whichever internal organ is affected, corresponding external signs appear. For instance, yawning and sudden chest oppression signify smallpox involving the Liver Meridian; coughing with phlegm, sneezing, tearing, and rhinorrhea signify involvement of the Lung Meridian; palpitations, irritability, and flushed face signify involvement of the Heart Meridian; drowsiness, spontaneous diarrhea, and limb heat signify involvement of the Spleen Meridian. Only when the Kidney Meridian presents with coolness of the ears and sacrum does it indicate that Fire cannot overcome Water. The morphology of Liver smallpox is a water blister, green and small; Lung smallpox is a pus blister, white and large; Heart smallpox is red and small; Spleen smallpox is yellowish and large. As for the Kidney Meridian, signs should not typically manifest; if Water fails to control Fire resulting in black-colored pox, it is not a auspicious sign.