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In treating any disease, one must first clearly distinguish between Cold (Han), Heat (Re), Deficiency (Xu), and Excess (Shi). The four diagnostic methods of Observation (Wang), Listening and Smelling (Wen), Inquiry (Wen), and Palpation (Qie) are all aimed at distinguishing these four aspects. If these four aspects are clearly understood in the mind, then the efficacy of medication will be as immediate as an echo. If these four cannot be distinguished, errors are rarely avoided. Even if the disease is cured by chance, it is merely a lucky coincidence. Regarding the Cold, Heat, Deficiency, and Excess of Smallpox (Dou Zheng), this distinction is particularly crucial; failure to clarify them often leads to treatment failure. Why is it that physicians throughout history who have written books and formulated prescriptions for Smallpox have held differing views? They often neglected or failed to clearly distinguish between Deficiency, Excess, Cold, and Heat. This leaves practitioners consulting these texts without a clear starting point, unable to determine which symptoms belong to Deficient Heat (Xu Re) and which to Excess Heat (Shi Re), nor which formula to use. Consequently, even with thousands of excellent formulas and theories, they are of no practical use. No wonder that from ancient times to the present, many Smallpox physicians have lost their way, and the art of caring for infants has become neglected.

Furthermore, the Deficiency, Excess, Cold, and Heat of Smallpox differ inherently from those of other diseases. In other diseases, Deficiency refers to the deficiency of Yuan Qi (Primal Qi), which requires tonification. In Smallpox, there is Exterior Deficiency (Biao Xu) and Interior Deficiency (Li Xu), also stemming from Yuan Qi deficiency, which likewise requires tonification. This is a similarity. In other diseases, Excess refers to the excess of pathogenic factors, requiring purgation. In Smallpox, Exterior Excess and Interior Excess indicate that the Yuan Qi is solid and the toxin cannot cause harm; thus, purgation is neither indicated nor necessary. This is a difference. In other diseases, severe Deficiency implies an excess of Yin and insufficiency of Yang, leading to Cold generated from Deficiency, which should be treated with warm and hot tonifying agents. In Smallpox, severe Deficiency similarly involves an excess of Yin and insufficiency of Yang, generating Cold from Deficiency, and also requires warm and hot tonifying agents. This is a similarity. In other diseases, Cold entering from the exterior is an external contraction; when the pathogen is on the surface, dispersing methods are appropriate. If it lingers and enters the interior, it stagnates and transforms into Heat, requiring clearing and resolving methods. In Smallpox, if Wind-Cold attacks after eruption, mild dispersing methods are appropriate. If external cold enters the interior causing vomiting and diarrhea, warming methods are sufficient; exterior diaphoresis is contraindicated, and interior clearing/resolving is not indicated. In other diseases, Deficient Heat arises from deficient Yuan Qi and exhausted essence/fluids, with Fire generated from Deficiency; tonification removes the heat without needing specific heat-clearing. In Smallpox, Deficient Heat involves deficient Yuan Qi and rampant toxins; the primary approach is to tonify Yuan Qi, with slight adjunctive detoxification. These three categories share both similarities and differences. In other diseases, Excess Heat occurs when blood and qi are not yet depleted but pathogens are abundant; simple cooling and purging herbs suffice. In Smallpox, Excess Heat occurs when constitution is strong, blood and qi are robust, and toxins are also abundant; simple cooling and resolving methods suffice. This is another similarity.

From the initial fever until recovery, one must first distinguish the Deficiency, Excess, Cold, and Heat of Smallpox, and subsequently prescribe formulas accordingly. This allows practitioners to carefully assess symptoms before medicating, thereby avoiding making Deficiency more Deficient and Excess more Excessive, preventing damage to what is insufficient while augmenting what is already excessive, and avoiding adding water to coldness or fire to heat. However, the Deficiency, Excess, Cold, and Heat of Smallpox are more readily observable than those of other diseases. From the appearance of spots to scabbing, the morphology and color are clearly visible. By listening to the voice, observing calmness or agitation, checking food and fluid intake, and assessing the ease or difficulty of urination and defecation, and by palpating the pulse (Slow Chi, Rapid Shuo, Surging Hong, Fine Xi) in children over three years old, one can distinguish Deficiency, Excess, Cold, and Heat. Once these distinctions are as clear as black and white, prescribing medication becomes straightforward and effective results are easily achieved.