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According to schedule, collect fresh variola vaccine (smallpox vaccine) for inoculation. Human-to-human transmission is indeed effective. However, this can only be applied locally; if the distance is far, it is difficult to obtain fresh vaccine. One may seek high-quality scabs (scab of smallpox) as described in the previous method, store them in a jar, seal tightly, carry them on one's person day and night without separation, which allows preservation for ten days or half a month. If immediate use is not possible, on the day of inoculation, place the back of the scab over the fresh vaccine to allow its qi (vital energy) to moisten it. Alternatively, dip the tip of a knife in fresh vaccine and smear it over the back of the scab. Whenever using the scab, prepare a small amount of human milk (Ren Ru). Scrape the flesh from within the scab with the knife tip (this refers to the pus-formed tissue on the side facing the flesh of the scab), place it on a porcelain surface, drip human milk onto it to moisten it, then grind and mix into a milky paste with the knife tip. Apply according to the method by pricking the arm. This is specifically for cases where the road is too far to obtain fresh vaccine; even scabs can achieve efficacy.

There is also a dry seedling method. Take two small ivory pins, and dip each into the pustules of children full of vaccine two or three times. Wait until they are dry, store them in goose quill tubes, seal with wax, and they can be kept for two or three days. When using, prepare a bowl of clear water and boil it. Moisten the ivory pin over the steam of the boiling water, scrape off the floating vaccine, and gather it onto the tip of the dry pin. Immediately use a knife to prick the skin membrane of the child as before, then insert the pin into the pierced hole, gently rocking it slightly so that the micro-blood washes the vaccine into the skin. Alternatively, insert the pin with vaccine into boiling water, immediately lift it out, shake off the water, and use as directed. However, with the dry seedling method, some induce a reaction while others do not; it is inferior to using scabs, and even more inferior to using fresh vaccine, because fresh vaccine retains the complete qi, which is the natural principle.

After inoculation, there is no fever. For the first three days, the inoculated site often feels like an ant bite. However, on the third or fourth day, signs begin to appear, the pustule tip emerges, and blood stains fall from the apex. On the fifth and sixth days, the lesion rises like a small papule, surrounded by fluid accumulation. On the sixth and seventh days, the fluid fills and suppuration occurs, with slight itching felt. On the eighth and ninth days, suppuration is complete, slight pain is felt under both armpits, resembling lymph nodes slightly; mild heat is seen on the forehead, head, and palms. This indicates the body's toxins are exiting through here; toxin emergence causes fire movement, requiring Yuan Yang (Primordial Yang) to transform and transport. The suppurating pustules vary in size, some like mung beans, others like white beans. On the ninth and tenth days, the red halo around the base dissipates, mild heat recedes, and the fluid turns yellowish-wax color. First, the center of the pustule becomes hard and dark, forming a scab. After half a month, the scab falls off leaving a scar. The scab is glossy, firm, and thick, with curled edges resembling small mushrooms. Looking closely at the scar, there are smaller scars within. When these conditions are complete, success can be declared! I have personally experienced this, so I know it in greater detail.

For natural smallpox (Tian Xing Dou), physicians first discuss the appearance of maturity. For cowpox (Niu Dou), one must distinguish between true and false. True pustules have a flat but not pointed apex, a tight and compact base, a color like pearl luster, a hard center point, a root encircled by a red line, and a red halo outside the base (a red halo appears only if congenital toxicity is heavy; if light, there is none). Such cases are true smallpox. Pustules with no fluid, no plasma, no red root line, or those that accumulate fluid but do not suppurate, or where suppuration resembles yellow-white pus, have a pointed but uneven apex, a scattered and wrinkled base that does not tighten, a pale dull color without luster, thin yellow scabs, and thickness in the center but thin at the edges. These are false smallpox. Once true smallpox has erupted, natural smallpox will never recur; even if re-inoculated, it will not recur again. False smallpox requires re-inoculation, fearing recurrence upon exposure to natural smallpox. One must clearly distinguish these aspects. Children undergoing inoculation must be examined by the original inoculator after suppuration begins to ensure accuracy.

Natural smallpox erupts via the Five Zang Organs and one Meridian; cowpox is similar. Occasionally, there is slight startle or convulsion during sleep, or slight irritability, indicating involvement of the Heart Meridian. Slight increase in eye discharge indicates Liver Meridian involvement. Slight thirst, stuffiness, vomiting, or diarrhea indicates Spleen Meridian involvement. Slight coughing and sneezing indicates Lung Meridian involvement. Teeth grinding during sleep indicates Kidney Meridian involvement. Why is medication unnecessary despite involving the five meridians? Because inoculation results in mild symptoms; the toxin does not spread horizontally, so symptoms naturally follow a smooth course.

Inoculating cowpox is best done before natural smallpox arrives to vent the pathogen. It is feared that if a child catches the aura of natural smallpox, and inoculation coincides with this time, the child may develop natural smallpox instead of cowpox, or both simultaneously. If fever occurs on the day of sowing or the next day, this is natural smallpox acting first, not cowpox eruption; otherwise, it may be a concurrent cold or other syndrome, requiring medical consultation. There are profit-seeking individuals who act cleverly, using natural smallpox vaccine for inoculation, resulting in widespread eruption when it breaks out. Those with light congenital toxicity produce few pustules with little harm; those with heavy toxicity produce many pustules, requiring treatment. If following the cowpox method, using the inoculated seedling on a person, one seed yields one pustule; there is absolutely no reason for excess. The inoculated acupoint produces the pustule there; there is no reason for horizontal spread elsewhere. Inoculators should be cautious.

Although cowpox does not typically produce excess, can four or six seeds fail to fully erupt? Answer: Yes. What then? Answer: No harm.

At the beginning of inoculation, for the first four or five days, one should eat ham, cured duck, lean pork, fresh fish, vegetables, tofu, winter bamboo shoots, coriander, water chestnuts, sugarcane, clear soup, congee, rice, and all light and bland foods. If diarrhea occurs, avoid fishy foods. After suppuration, avoid coriander, winter bamboo shoots, tofu, sugarcane, and water chestnuts, as these are cooling. During the fluid-accumulation stage, if the patient appears weak, consume a little fresh shrimp or crab to promote fluid production; if robust, abstinence is fine. Avoid raw chicken, carp, and beef; mistaken consumption may cause pustules to break and form pits that fail to close, or cause redness and swelling around the scab after healing, resembling varioliform eruptions. Also avoid fried, roasted, heat-toxic, and sticky wheat products. At the initial stage of seeding, avoid overly sour or salty foods; excessive tofu consumption may also cause itching.