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In cases where a smallpox patient has a warm body throughout and suddenly develops high fever at the stage of scabbing, this is commonly known as "dry pus" (Gan Jiang), which is also a common occurrence. One must only fear that it is caused by internal injury from diet or external contraction of wind-cold leading to ear complications. However, since prolonged illness leads to Qi deficiency, one should not lightly employ sweating or purging methods. If caused by external pathogenic factors, use Shen Su Yin (Ginseng and Perilla Decoction); if caused by internal dietary injury, use Mu Xiang Da An Wan (Aucklandia Great Peace Pill), merely to assist stomach Qi, transform food, and promote the circulation of grain Qi.

The odor associated with the Heart is scorched; with the Liver, it is rank/fishy (Sao); with the Spleen, it is fragrant; with the Lung, it is raw/meaty (Xing); and with the Kidney, it is putrid (Fu). Yet, all odors are attributed to the Heart, hence it is said that odors arise from Fire transformation. When smallpox emits an odor only at the scabbing stage, this indicates that at the time of maturation, the pathogenic factor is exiting from within, which is a favorable sign. If an odor appears during the stage of nourishing pus, this indicates foul air from toxic fire accumulating internally and manifesting externally, which is an ominous sign. Regarding itching, scratching until ulceration occurs, and during the stage of swelling and suppuration: if the odor is rank (Sao), it indicates excessive Liver Fire, which is fatal. If the odor is scorched (Jiao), it indicates excessive Heart Fire; if the odor is raw/meaty (Xing), it indicates excessive Lung Fire; both are critical conditions. If the odor is putrid (Fu), it indicates flourishing Kidney Fire. Or if the odor comes from rotting pustules, all are fatal and untreatable. Only when the odor is fragrant, corresponding to the Spleen—the mansion of water and grain, which receives everything—is it considered a favorable prognosis. In particular, one should verify this by observing whether the patient can eat, combined with other symptoms.

If smallpox lesions do not normally scab but suddenly turn purple all at once, this is called "inverted scabbing" (Dao Ye) and belongs to critical conditions. If the lesions should scab but do not, and instead suddenly sink inward, this is also termed "inverted scabbing," and is even more indicative of a fatal condition. If the original Yuan Qi is weak, the patient cannot eat, and suffers from spontaneous diarrhea, then Chen Shi Mu Xiang San (Chen's Aucklandia Powder) should be used; this is indeed a sacred medicine for seeking life amidst death. If there was originally no diarrhea, but rather long-term constipation, abdominal distension, and panting/calling out, this is because excessive toxin has eroded the Yuan Qi and re-entered the interior. Urgent purging is required. If purging is not urgent, the intestines and stomach will become obstructed, Ying and Wei (Nutritive and Defensive Qi) will fail to circulate, leading to increased panting, fullness, restlessness, stifling sensation, and death. If the toxin enters the interior and sudden spontaneous diarrhea occurs, expelling scabs, pus, and blood, this is because the person's Spleen and Stomach were originally strong, making it difficult for the toxic qi to remain; thus, through spontaneous diarrhea, the toxic qi is expelled, which is a favorable progression. Do not stop it; wait for the pus and toxins to be completely discharged, and self-healing will occur. If watery stool containing undigested food is passed, this is due to Spleen Qi deficiency being unable to overcome the pathogen, so the toxic qi drives the water and grain out instead; this is an untreatable condition.