死。每当出痘之年。枉死载道。全不知惨。此等恶医。皆有豺野狼之心也。
自古治痘名家。不啻廿数。各有精确卓识。以补前人之未备。虽各有所偏。实所以相济也。
医者贵统汇群书。随宜施治。安可执偏隅管见。以应无穷之变哉。先生治痘。夙称神奇。观
其案中。寒热攻补。不胶于一见。如毒火深伏。气血壅遏者。藉芳香以搜逐。用紫雪丹。气滞
血凝。毒重火伏者。以酒大黄石膏青皮桃仁荆芥犀角猪尾血之类主治。肝肺毒火不宣。
气血有焦燔之势者。用犀角羚羊紫草丹皮石膏鲜生地之类。元气不支。阳虚毒陷。而见
灰白湿烂。泄泻呕恶等症者。用辛香温煦。如陈文仲之法为要。气血极虚。而浆清塌痒。全
无实症相兼者。当峻补气血。用参归鹿茸汤。及坎 汤之类。气虚莫外乎保元及四君子。
血虚不离于四物及补血汤。又有气虚血热者。补气之中兼凉血。血虚气滞者。补血之中
佐辛香。用攻法须分部位经络。用补法当辨寒热燥湿。过清则有冰伏之虑。偏热则有液
涸之虞。此皆先生采择先贤之法。因人见症而施治。可谓善法古者矣。夫痘虽以形色辨
其吉凶。然内症尤为紧要。如痘点既起。或不慎风寒。而营卫凝涩。或纵恣饮食。而气机呆
钝。以致身热不食。腹膨呕恶泄泻。浆水不行。不究治其病因。但执清寒腻补。常有凶危之
变。亦有痘形虽重。若神宁安静。饮食二便如常。声音清响。调理得宜。亦可转危为安。大凡
形老而色鲜明者。虽甚密。变幻恒少。形嫩而色晦滞者。虽稀疏。变幻恒多。表里相参。审症
的确。然后设法处治。方无贻误。至于逆症条款已现。虽自昔名医。亦莫能挽救。小儿夭枉
者。不可胜数。深可怜悯。迩年以来。幸有种痘一法。盛行于世。实可挽回造化。凡有小儿者。
俟周岁后。即可选用种痘之苗。引而发之。百不失一。此诚补痘科之未备。而为最上一乘
之法也。正痘有先贤诸成法。避险有种痘之良方。痘症于是乎大全矣。（陆履安）
痘之发也。一由乎胎毒内伏。一由于外感时邪之气引导而出。其症之顺逆。若内毒轻而
外感之气亦轻者。痘必稀疏。此为顺症。苦内毒轻。而外感之气重者。虑其遏闷不齐。不易
灌浆。若能至灌浆。则时邪渐退。后易收功。此为先重后轻症。若内毒重。而外感之气轻者。
虑其灌浆已后。毒难尽泄。不易收靥结痂。恐发痘毒疳蚀之患。此为先轻后重症。若内毒
重而外感之气亦重者。痘必稠密。色不鲜泽。发热见点之后。一路蹭蹬。难以收功。此为逆
症。然胎毒之轻重。人皆易明。若外感之气。人莫能晓。夫天地间。只有六气。气平则为和气。
不平则有胜复。胜复至极。则为厉气。为瘟疫气。瘴气。更有道涂中秽浊气。人若感之。不拘
老幼俱病。今出痘所感之气。则异乎是。此气独与未泄胎毒之小儿。两相感触。未闻痘症
盛行之时。已出过痘之儿。亦染病患也。考是气。自古迄今。从未有人申帮助白。确定为何
气。故前贤于痘症一科。未尝不殚心瘁虑。立论著方。因不明其气之源。不无偏执之弊。有
喜于寒泻者。有喜于温托者。有先用寒泻。而后用温补者。有先用温托。而后用清火解毒
者更有不审儿体之虚实寒热。俱宗费建中救偏琐言。每于发热见点时。概用大黄石膏
黄连犀角羚羊茅根芦根等。不知费氏之书。名为救偏。乃救惯用热药之偏耳。若本不偏。
而宗其法。则不偏者。反至偏矣。婴儿之命。其何以堪。幸古有种痘良法。相传至今。其法简
易灵验。至稳至当。盖正痘因外感时邪而发。种痘则种于无病之时。故所出稀疏。轻者不
过几十粒。此岂非避危就安之妙法乎。倘愚人不信。何不将自出与种出。彼此相较。其理
自明。假使一村之中。有百儿出天花。未尝不延医服药。若能八九十收功。人咸称为太平
痘矣。甚有竭力调治。而损伤几及一半者。不闻其归咎于医生。惟有委命于天而已。今若
种百儿之痘。设或损伤四五个。则必责罚种师。并不容其托足于此一村矣。人何笃信医
生。而不相信种师耶。与其委命于天。孰若以人功挽之。以此相较。则当种与不当种自决
矣。至于种法。全在乎好苗夫。苗者。即取他儿之痘痂也。必要用种出之痘。落下之痂。谓之
种苗。此苗之中。毫无天行时毒之气在内。故放心可用。若自出天花之痂。谓之时苗。此苗
之中。有时行之气。若不辨而用之。名虽为种。实与传染他儿天行时痘之气无异。此时苗
之不可用也。然种苗之内。尚要拣择。必取痘粒稀少。其色红润。灌浆浓浓。所结之痂。浓实
光泽尖圆者。此气血充足。阴阳合德。上好之苗也。俟痂落下。用纸包好。记明何日收得。收
贮新瓷瓶内。紧护其口。置清凉之处。勿触秽热之气。其苗在北方。天气凉。春月之苗。一月
之内。尚可种。冬月之苗。四五十日尚可种。南方气温。夏月之苗四五日。春月之苗二十日。
冬月之苗三十日。若延日久。则气薄无力。恐种不出矣。欲觅此等种苗。先访有人家正在
种痘之际。向彼明言其故。恳求四五粒。即可源源而种。或平日于同道种师内。相与一二
位志诚老实者。议明彼此互借。则苗亦可不断。亦有胆大种师。于五六月中。觅贫家壮实
之儿种之。不惟不索酬谢。反肯津贴银钱。次递传种三四个儿。延至七月。则苗亦可以不
断矣。近有种师。因种苗已断。权取时苗种之。往往有种出稠密棘手重痘者。皆时苗之过
也。不知时苗之性。即选上好者。亦必要传种过四五儿俱各顺当者。其苗性始和平。方能
与种苗相等。至于下手种法。尤须详慎。凡种一儿。用痘痂三四粒。两儿则用六七粒。放于
干净茶杯中。倾入清水四五茶匙。用小指尖在内三四搅。则痂已湿。急将水倾去。用柳木
杵研。其杵约长四寸。粗如笔管。两头要光圆。研十数转足矣。如痂太干。加入清水一二滴。
切不可太潮。只要研如干浆糊状。用弹熟新棉花。捏一小团。如枣核大。两头要圆。其长短
粗细。量儿鼻孔之大小为之。其棉团不可太松软。松则苗气易往外泄。且见涕则缩小。易
于脱出。将棉团只用一头。蘸痂末糊于上。塞儿鼻中男左女右。塞不可太进太进则儿不
适意。亦不可太出。太出则易于脱落。总要宽紧浅深适中为妙。塞后勿放小儿用手拈出。
若被喷嚏打出。急将苗仍塞入鼻。下苗后。以六个时辰为度。天气热。早取出数刻。天气寒。
多留数刻。痘苗取出之后。其苗气渐次传遍五脏。至七日。或八九日始发热。发热三日而
见点矣。此诚至稳至当之种法也。种痘之苗。不过痘痂一味。今各处种师。诡称痘痂之外。
尚要加他药为引导者。此系惑人谎语。切勿信之。既种后。将发热时。小儿颈项内。男左女
右。必发一小块。状如痰核。此乃毒瓦斯结聚于此。故痘发必稀疏。此块不必医治。待落痂后。
则块亦渐消矣。若用时苗种者。项中无块。当以此辨之。又间有惊痘。于发热时。小儿忽然
惊搐。手足蜷。不语。目上视。有片时即平复者。有发一二个时辰者。有发一次者。有发两次
者。总属不妨。斯时切不可扰动叫唤之。待其自平即已。不必服药。须预对痘家帮助。免其
忧虑以上诸论。皆时下种师之秘诀也。若夫辨儿之可种与不可种。须察儿体之虚实。及
有无宿病。若调治之法。当节饮食。适寒温。防惊吓。此皆种师俱各明悉。兹不重赘。（郑望颐）
死亡。每当出痘的年份，道路上横尸无数，人们全然不知其惨状。这些恶劣的医生，都怀着豺狼般的心肠。
自古以来治疗天花的名家，不止二十多位，各自都有精确卓越的见识，以补充前人的不足。虽然各有所偏重，但实际上是相互补益的。
医生贵在汇总群书，根据具体情况施治，怎么能固执于片面的见解，来应对无穷的变化呢？先生治疗天花，素来被称为神奇。看他的医案中，寒热攻补，不拘泥于一种看法。比如毒火深伏，气血壅滞遏阻的，借助芳香药物来搜剔驱逐，使用紫雪丹；气滞血凝，毒重火伏的，用酒大黄、石膏、青皮、桃仁、荆芥、犀角、猪尾血之类主治；肝肺毒火不宣，气血有焦灼焚烧之势的，用犀角、羚羊角、紫草、丹皮、石膏、鲜生地之类；元气不支，阳虚毒陷，而出现灰白湿烂、泄泻呕恶等症状的，用辛香温煦的方法，如陈文仲的法度为要；气血极虚，而浆液清稀、塌陷瘙痒，完全没有实证相兼的，应当峻补气血，用人参当归鹿茸汤，以及坎离既济汤之类。气虚莫过于保元汤及四君子汤；血虚离不开四物汤及补血汤。又有气虚血热的，在补气之中兼用凉血药；血虚气滞的，在补血之中佐以辛香药。使用攻法必须区分部位经络，使用补法应当辨别寒热燥湿。过度清热则有冰伏（邪气被寒凉遏制不能透发）的顾虑，偏于温热则有津液枯竭的忧虑。这些都是先生采纳先贤的方法，根据病人的具体症状而施治，可以说是善于效法古人了。
虽然天花可以通过形色辨别吉凶，但内症尤为紧要。比如痘点已经发出，如果不慎受风寒，导致营卫凝涩；或者放纵饮食，导致气机呆钝，以致身热不食、腹部膨隆、呕恶泄泻、浆水不行。如果不探究病因，只是固执于清寒腻补，常有凶险危重的变化。也有痘形虽然严重，但如果神志安宁安静，饮食二便如常，声音清亮响亮，调理得当，也可以转危为安。大凡痘形老练而色泽鲜明的，虽然很密集，变幻通常很少；痘形娇嫩而色泽晦暗滞涩的，虽然稀疏，变幻通常很多。表里参合，审症确切，然后设法处治，才不会贻误。至于逆症的条款已经显现，即使是自古以来的名医，也不能挽救。小儿夭折枉死的，不可胜数，深深令人怜悯。
近年来，幸好有种痘一法，盛行于世，实在可以挽回造化。凡是家有小儿的，等到周岁后，就可以选用种痘之苗，引导并发出来，百不失一。这确实是补充痘科治疗的不足，是最上乘的方法。正痘（自然感染天花）有先贤的各种成法避险，有种痘的良方，痘症的治疗于是乎完备了。（陆履安）
痘的发生，一是由于胎毒内伏，一是由于外感时邪之气引导而出。其病症的顺逆，如果内毒轻而外感之气也轻的，痘必稀疏，此为顺症。苦于内毒轻，而外感之气重的，担心其遏闷不齐，不易灌浆。如果能至灌浆，则时邪渐退，后易收功。此为“先重后轻”症。如果内毒重，而外感之气轻的，担心其灌浆以后，毒难尽泄，不易收靥结痂，恐发痘毒疳蚀之患。此为“先轻后重症”。如果内毒重而外感之气也重的，痘必稠密，色不鲜泽，发热见点之后，一路坎坷，难以收功。此为逆症。然而胎毒的轻重，人都容易明白，若外感之气，人却不能知晓。天地间只有六气，气平则为和气，不平则有胜复（五行生克制化的异常）。胜复至极，则为厉气、瘟疫气、瘴气。更有道路中的秽浊气，人若感之，不拘老幼都会生病。现在出痘所感之气，则不同于此。此气独与未泄胎毒的小儿两相感触。未曾听说痘症盛行之时，已出过痘的孩子，也会染病患病。考察这种气，自古迄今，从未有人申述帮助阐明，确定为何气。所以前贤对于痘症这一科，未尝不殚心瘁虑，立论著方。因为不明其气的源头，不无偏执的弊端。有的喜欢用寒泻，有的喜欢用温托，有的先用寒泻而后用温补，有的先用温托而后用清火解毒。更有不审察小儿体质的虚实寒热，都宗奉费建中《救偏琐言》，每于发热见点时，一概用大黄、石膏、黄连、犀角、羚羊角、茅根、芦根等。不知道费氏的书，名为救偏，乃是救治惯用热药的偏颇罢了。如果本来不偏，而宗奉其法，那么不偏者反而至偏了。婴儿的生命，怎么承受得住呢？幸好古有种痘良法，相传至今。其法简易灵验，至稳至当。大概正痘因外感时邪而发，种痘则是种于无病之时，所以所出的痘稀疏，轻者不过几十粒。这难道不是避危就安的妙法吗？
倘若愚人不信，何不将自出（自然感染）与种出（人工接种）彼此相较，其理自明。假使一个村子中，有一百个儿童出天花，未尝不延请医生服药。若能八九十个收功，人们都称为太平痘了。甚至有竭力调治，而损伤几乎一半的，也不听闻归咎于医生，只有把命运交给天而已。现在如果种一百个儿童的痘，假设损伤四五个，则必定责罚种痘师，并不容他在该村立足。人为什么笃信医生，而不相信种痘师呢？与其把命运交给天，不如以人力挽回它。以此相较，则应当种与不种自然决定了。
至于种法，全在乎好的种苗夫。苗，就是取其他孩子的痘痂。一定要用种出来的痘，落下之痂，称为种苗。这个苗中，毫无天行时毒之气在内，所以放心可用。如果是自然出天花之痂，称为时苗。这个苗中，有时行之气。若不辨别而用之，名虽为种，实则与传染其他孩子天行时痘之气无异。这就是时苗不可用的原因。然而在种苗之内，尚要拣择。必须取痘粒稀少，其色红润，灌浆浓浓，所结之痂，浓实光泽尖圆的，这是气血充足，阴阳合德，上好的苗。等到痂落下，用纸包好，记明何日收得，收贮在新瓷瓶内，紧护其口，置于清凉之处，勿触秽热之气。其苗在北方，天气凉，春月之苗，一个月之内，尚可种；冬月之苗，四五十日尚可种。南方气温高，夏月之苗四五日，春月之苗二十日，冬月之苗三十日。若拖延日久，则气薄无力，恐怕种不出来了。想寻觅此类种苗，先访问有人家正在种痘之际，向彼明言其故，恳求四五粒，即可源源而种。或者平日于同道种师内，相与一二位志诚老实者，议明彼此互借，则苗亦可不断。也有胆大的种痘师，在五六月中，觅贫家壮实之儿种之，不惟不索酬谢，反肯津贴银钱，次递传种三四个儿，延至七月，则苗也可以不断了。近来有种痘师，因种苗已断，权取时苗种之，往往有种出稠密棘手重痘者，都是时苗的过错。不知道时苗的性质，即使选上好的，也必要传种过四五儿俱各顺当者，其苗性始和平，方能与种苗相等。
至于下手种法，尤须详慎。凡种一个孩子，用痘痂三四粒，两个孩子则用六七粒，放于干净茶杯中，倾入清水四五茶匙，用小指尖在内三四搅，则痂已湿，急将水倾去，用柳木杵研。其杵约长四寸，粗如笔管，两头要光圆，研十数转足矣。如痂太干，加入清水一二滴，切不可太潮，只要研如干浆糊状。用弹熟新棉花，捏一小团，如枣核大，两头要圆，其长短粗细，量孩子鼻孔的大小为之。其棉团不可太松软，松则苗气易往外泄，且见涕则缩小，易于脱出。将棉团只用一头，蘸痂末糊于上，塞入孩子鼻中，男左女右。塞不可太进，太进则孩子不适意，亦不可太出，太出则易于脱落。总要宽紧浅深适中为妙。塞后勿放孩子用手拈出。若被喷嚏打出，急将苗仍塞入鼻。下苗后，以六个时辰为度。天气热，早取出数刻；天气寒，多留数刻。痘苗取出之后，其苗气渐次传遍五脏，至七日，或八九日始发热，发热三日而见点矣。这真是至稳至当之种法。
种痘之苗，不过痘痂一味。如今各处种痘师，诡称痘痂之外，尚要加他药为引导者，这是惑人的谎语，切勿信之。既种后，将发热时，小儿颈项内，男左女右，必发一小块，状如痰核，这是毒瓦斯结聚于此，故痘发必稀疏。此块不必医治，待落痂后，则块亦渐消矣。若用时苗种者，项中无块，当以此辨之。又间有惊痘，于发热时，小儿忽然惊搐，手足蜷缩，不语，目上视，有片时即平复者，有发一二个时辰者，有发一次者，有发两次者，总属不妨。此时切不可扰动叫唤之，待其自平即已，不必服药。须预先对痘家帮助，免其忧虑。以上诸论，皆时下种痘师的秘诀。至于辨别孩子可种与不可种，须察孩子体质的虚实，及有无宿病。若调治之法，当节饮食，适寒温，防惊吓。这都是种痘师各自明悉的，兹不重赘。（郑望颐）
Death. In years when smallpox breaks out, corpses litter the roads, and people are completely unaware of the tragedy. These malicious physicians harbor hearts like jackals and wolves.
Since ancient times, renowned masters in treating smallpox have numbered more than twenty, each possessing precise and outstanding insights to supplement the deficiencies of their predecessors. Although each had their own biases, these were actually complementary to one another.
A physician should be adept at synthesizing various medical texts and applying treatments according to specific circumstances. How can one cling to partial views to cope with infinite variations? Mr. Ye's treatment of smallpox was long renowned for its miraculous efficacy. Observing his case records, he did not adhere rigidly to a single approach regarding cold, heat, purging, or tonification. For instance, when toxic fire lay deep within and qi and blood were stagnant and obstructed, he employed aromatic herbs to search out and expel the pathogen, using Zixue Dan (Purple Snow Pill). When qi stagnation and blood coagulation occurred with heavy toxicity and hidden fire, he treated it with substances such as Jiuda Huang (Rhei Radix et Rhizoma prepared with wine), Shigao (Gypsum Fibrosum), Qingpi (Aurantii Fructus Immaturus), Taoren (Persicae Semen), Jingjie (Schizonepetae Herba), Xijiao (Rhino Ceratostis - *Note: now protected/substituted*), and Zhuweixue (Porcine Tail Blood). When liver and lung toxic fire failed to diffuse, and qi and blood showed signs of scorching and burning, he used Xijiao (Rhino Ceratostis), Lingyangjiao (Saiga Tataricae Cornu), Zicao (Arnebiae Radix), Danpi (Moutan Cortex), Shigao (Gypsum Fibrosum), and Xianshengdi (Rehmanniae Radix Recens). When primordial qi could not support itself, yang deficiency led to toxin sinking, presenting with grayish-white, wet, and rotting lesions, diarrhea, vomiting, and nausea, he employed pungent, aromatic, and warming methods, following the principles of Chen Wenzhong. When qi and blood were extremely deficient, presenting with clear/thin pustule fluid, collapse, and itching, without any excess syndromes, he advocated vigorous tonification of qi and blood, using Renshen Guilu Tang (Ginseng, Deer Antler, and Angelica Decoction) or Kanli Jiji Tang (Decoction for Reuniting Kidney and Heart). For qi deficiency, Baoyuan Tang (Preserve the Origin Decoction) and Sijunzi Tang (Four Gentlemen Decoction) were paramount; for blood deficiency, Siwu Tang (Four Substances Decoction) and Buxue Tang (Tonify Blood Decoction) were essential. In cases of qi deficiency with blood heat, cooling blood herbs were added to qi-tonifying formulas; in cases of blood deficiency with qi stagnation, pungent and aromatic herbs were added to blood-tonifying formulas. When using purgative methods, one must distinguish by body region and meridians; when using tonification, one must differentiate cold, heat, dryness, and dampness. Overuse of clearing/cooling agents risks "ice-fusion" (pathogenic cold freezing the pathogen inside); bias toward heat risks depletion of body fluids. These methods reflect Mr. Ye's adoption of sages' techniques, applied according to individual presentations, truly exemplifying the skillful emulation of ancients.
Although smallpox prognosis is often judged by shape and color, internal symptoms are particularly critical. If, after eruption, the patient contracts wind-cold causing Ying and Wei levels to become stagnant, or indulges in diet leading to sluggish qi mechanism, resulting in fever, anorexia, abdominal distension, vomiting, diarrhea, and failure of pustule formation, failing to address the cause and merely adhering to cold/clearing or cloying tonification often leads to fatal outcomes. Conversely, even if the rash appears severe, if the spirit is calm, diet and excretion are normal, voice is clear, and care is appropriate, critical conditions can turn to safety. Generally, old/mature rashes with bright colors, though dense, undergo few transformations; tender rashes with dull colors, though sparse, undergo many transformations. By correlating interior and exterior, confirming the syndrome accurately, and then devising treatment, errors are avoided. Once reverse syndromes manifest fully, even ancient famous doctors cannot save the patient. Countless children die prematurely, which is deeply pitiable.
In recent years, fortunately, vaccination has become prevalent, truly reversing fate. For families with infants, vaccination can be performed after one year of age, inducing immunity with near-perfect success. This indeed supplements the deficiencies of smallpox therapy, representing the highest level of method. Natural smallpox has established methods from sages to avoid danger, while vaccination offers excellent prescriptions, making smallpox management comprehensive. (Lu Lü'an)
The emergence of smallpox stems from two sources: latent fetal toxins and guidance by external seasonal pathogens. The course (smooth vs. reverse) depends on the balance: if internal toxin is light and external pathogen is light, the rash will be sparse (Smooth Syndrome). If internal toxin is light but external pathogen is heavy, obstruction may prevent uniform eruption and filling of pustules; however, if filling occurs, the pathogen recedes, facilitating recovery (Heavy-then-Light Syndrome). If internal toxin is heavy but external pathogen is light, after filling, the toxin may not fully excrete, hindering crusting and risking toxic ulcers (Light-then-Heavy Syndrome). If both internal toxin and external pathogen are heavy, the rash will be dense, dull-colored, and difficult to resolve (Reverse Syndrome). While fetal toxin severity is easily understood, the nature of the external pathogen is obscure. The world contains Six Qi; balanced, they are harmonious; unbalanced, they generate excess/recovery cycles. Extreme imbalance creates pestilential, epidemic, or miasmic qi, plus filth from roads. Infection affects all ages. However, the specific qi causing smallpox interacts uniquely with children carrying unfired fetal toxins. It is unheard of for those who have already had smallpox to contract it again during an epidemic. Historically, no one clarified this specific qi, leading past masters to rely on biased theories—some favoring cold/purging, others warm/supporting, alternating between them. Some ignored constitution and blindly followed Fei Jianzhong's *Jiu Pian Suo Yan*, using harsh cold herbs like Dahuang, Shigao, Huanglian, etc., upon fever/rash onset. Fei's book aimed to correct overuse of heat drugs; applying it to non-biased cases causes new imbalances, endangering infants. Fortunately, ancient vaccination remains, simple and effective. Natural smallpox arises from external pathogens; vaccination is done when healthy, yielding sparse, mild cases (dozens of spots). Is this not a brilliant method to avoid danger?
Skeptics should compare natural infection vs. vaccination. In a village with 100 natural cases, even with medical care, saving 80-90 is called "peaceful." Saving only half despite effort brings no blame to doctors, only resignation to fate. In vaccination, losing 4-5 out of 100 results in punishing the vaccinator. Why trust doctors more than vaccinators? Human effort surpasses fate. Comparison decides whether to vaccinate.
Vaccination relies on good "seed material" (crusts from vaccinated children, called *Zhong Miao*). These lack epidemic toxicity and are safe. Crusts from natural infection (*Shi Miao*) contain epidemic qi; using them is equivalent to natural infection and dangerous. Even among *Zhong Miao*, selection is key: choose sparse, red, well-filled pustules with thick, shiny, round crusts (indicating sufficient qi/blood and yin/yang harmony). Store dried crusts in paper, labeled with date, in new porcelain jars, sealed tight, kept cool away from filth/heat. Viability varies by climate: North (Spring: 1 month; Winter: 40-50 days); South (Summer: 4-5 days; Spring: 20 days; Winter: 30 days). Old crusts lose potency. To obtain seeds, ask families currently vaccinating for 4-5 crusts, or arrange exchanges with honest colleagues. Bold vaccinators sometimes use robust poor children in summer to propagate seeds through several generations until autumn. Recently, some use *Shi Miao* due to shortage, causing severe/dense reactions—a fault of *Shi Miao*. Even best *Shi Miao* must pass through 4-5 smooth vaccinations to stabilize before matching *Zhong Miao*.
Technique requires caution. Use 3-4 crusts per child (6-7 for two). Soak in clean water in a cup, stir gently with little finger, drain water. Grind with willow wood pestle (4 cun long, pen-thick, smooth ends) for ~10 turns. Add 1-2 drops water if too dry; aim for dry paste consistency. Roll into cotton ball (date-seed size, rounded ends), sized to nostril. Do not make too loose (qi escapes/shrinks with mucus). Dip one end in paste, insert into nostril (left for boys, right for girls). Depth must be moderate: too deep causes discomfort, too shallow causes falling out. Prevent child from picking it out. If expelled by sneeze, reinsert immediately. Keep for 6 hours (shorter in heat, longer in cold). After removal, vaccine qi spreads through five zang organs. Fever starts day 7-8, rash appears 3 days later. This is the most stable method.
Some claim adding other herbs guides the vaccine; this is false. Post-vaccination, around day of fever, a lump (like phlegm-nodule) may appear on neck (left for boys, right for girls), indicating toxin gathering; rash will be sparse. This lump resolves after crusting. If *Shi Miao* was used, no lump appears—use this to differentiate. Occasionally, "startled smallpox" occurs: sudden convulsions, curled limbs, silence, upward gaze during fever. May last moments to hours, once or twice. Harmless. Do not disturb or call out; wait for self-resolution. No medicine needed. Reassure parents. These are secrets of contemporary vaccinators. Determining suitability requires assessing constitution and chronic illness. Care involves regulating diet, temperature, and preventing fright. Vaccinators know this well. (Zheng Wangyi)