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The method for treating smallpox (Dou Zhen) emphasizes caution at the beginning and consideration of the final outcome, so as to avoid future regrets. The classics state: The superior physician treats the disease before it arises; the average physician treats it when it is about to arise; the inferior physician treats it after it has arisen. Treating before the disease arises yields success in eight or nine out of ten cases; treating when it is about to arise yields success in four or five out of ten cases; treating after it has arisen leaves little room for efficacy.

At the initial stage of fever, presenting with high fever, thirst, restlessness, constipation, abdominal and lower back pain, dry nose, dry lips, palpitations, and delirium, this indicates toxic qi stagnating and obstructing internally. At this point, one must prevent the toxin from lurking and failing to erupt. If vomiting and diarrhea persist, one must guard against deficiency of Middle Qi (Zhong Qi), which fails to assist in maturing the pustules, potentially leading to involution (Dao Xian). Therefore, heat should be resolved, constipation should be purged, palpitations should be calmed, and vomiting/diarrhea should be stopped.

Consider the initial eruption resembling a single blood spot; this corresponds to the Spring energy of generation. The subsequent rising phase corresponds to the Summer energy of growth. The transformation of vesicles into pus corresponds to the Autumn energy of fruition. The drying and crusting of pus corresponds to the Winter energy of storage. If fluid appears immediately upon initial eruption, or if the pustules fill with fluid before fully rising, or if they crust over before pus forms, this is termed "arriving before due time," known as Excess (Tai Guo). This inevitably leads to involution or hiding of the toxin. Methods such as releasing the exterior, supporting the interior, and detoxifying must not be delayed. Conversely, if eruption, rising, or crusting fails to occur when expected, this is termed "arriving but not arriving," known as Deficiency (Bu Ji). This is invariably attributed to deficient Qi and thin Blood. Methods such as regulating Qi, invigorating Blood, and detoxifying must be applied urgently.

Furthermore, if the initial eruption is bright red, the skin is tender; tender skin breaks easily, so one must guard against collapse due to itching. Clustering into masses does not indicate sparseness but rather hidden toxins. Pustules that are hollow and devoid of fluid will later develop abscesses. Premature swelling of the head and face requires guarding against easy resolution and involution. Sore throat requires urgent relief to prevent loss of voice or choking. Numerous vesicles in the center predict subsequent diarrhea. Dry eyes with tearing require guarding against corneal opacity (Fu Yi). Frequent bowel movements require guarding against premature crusting (Dao Ye); broken sores that fail to scab constitute Dao Ye.

Yao Fu stated: "It is better to prevent oneself before illness than to take medicine after illness." This is precisely what he meant.

The *Zhi Nan* states: Qi color is white, Blood color is red. At the initial emergence of smallpox toxin, Blood and Qi are unsettled, and auspicious/inauspicious signs are indistinct. The differentiation of red and white colors is not yet clear, appearing only as a faint red spot on the cheeks, ears, mouth, nose, and nasal tip (Nian Shou). Subsequently, a slight whiteness appears within, while the exterior remains faintly red; at this stage, fortune and misfortune are determined. Later, the base becomes rounded and mixed, the internal whiteness gradually enlarges, and the external faint redness gradually thins; at this point, the mechanism of fortune, misfortune, regret, and blame becomes apparent. Further on, when the pustules are sharp, round, glossy, and the internal whiteness is full, while the external red halo thins, the pustules begin to show signs of becoming filled with pus. The internal whiteness takes on a slight yellow hue while remaining vibrant and red. Advancing to the fifth or sixth day, although the internal whiteness may turn yellow, it remains between red and white; although the external red circle thins, it is not yet minute. By the sixth or seventh day, the internal whiteness turns pure yellow, though not yet old; the external attached red halo shows only a trace of redness and gloss. By the eighth or ninth day, the pustules mature into pus, round, clean, and plump, yellow without red halos; here, the sequence of Qi and Blood is normal, treatment is established, and efficacy is achieved. By the eleventh or twelfth day, gradual drying and yellowing appear, or the color resembles greenish pustules, indicating a time of Qi and Blood recovery. Although so, the risk of premature crusting remains and cannot be ignored. By the twelfth or thirteenth day, the dried yellow skin wrinkles and forms old crusts. Spreading from head/face to hands/feet is a favorable course (Shun); spreading from hands/feet to head/face is an unfavorable course (Ni). By the thirteenth or fourteenth day, the old crusts fall off. However, there is the hazard of old crusts failing to fall off, named "Lacquer Face Piercing Flesh," accompanied by body fever, red eyes and face, irritability, and thirst. There are cases of facial puffiness, swollen eyes, and nausea. There are cases where ulceration occurs from the crust flesh after crusting. There are cases of persistent fever, oral ulcers (Gan Shi), and white tongue coating. There are cases of toxicity in the four limbs or development of carbuncles (Ding Zhong). There are cases of white obstructions in the eyes or exposure of the sclera. Even if the smallpox has resolved, myriad disasters may arise; how can one neglect prevention simply because the crusts have aged? If the crusts fall off cleanly and smoothly, the treatment seems successful, yet it is not finished. There are cases of white scars remaining after crusts fall. There are cases of lingering chills and fever for over a month. There are cases of deep-seated abscesses (Liu Zhu) ulcerating, skin diseases like scabies and leprosy-like eruptions, thirst with mania and restlessness, or panting with thirst and agitation. Although the scabs have fallen, residual symptoms persist, and life or death cannot be guaranteed. Can those treating smallpox consider the falling of scabs as safety?