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The eruption of smallpox arrives following the path of fire; therefore, it often forces blood to move recklessly, with blood agitated by the heat. If the Yang collaterals are damaged, blood exits from the Upper Jiao (Upper Burner), manifesting as epistaxis or vomiting. If the Yin collaterals are damaged, blood exits from the Lower Jiao (Lower Burner), manifesting as hematuria or bloody stools. If both Yin and Yang collaterals are damaged, bleeding occurs in both upper and lower regions, or there may be seepage from between the pustules. However, why does excessive sleepiness and inability to wake occur after blood loss? This is because the Heart governs blood; when blood is lost, the Spirit of the Heart becomes confused, losing its ethereal clarity. Among all types of blood loss, only epistaxis is treatable; the rest are considered terminal conditions.

(Sui Jin Section)

When smallpox erupts after three to four days of tidal fever, it indicates sufficient Qi and Blood, with mild toxin that is difficult to stir, similar to how a hot fire is hard to ignite fuel; such eruptions will be sparse and easy to heal. When eruptions appear within half a day to one day of initial fever, it is due to weak Qi and Blood, with abundant toxin easily stirred, like a fierce fire burning readily; such eruptions will be dense and difficult to cure. Initial eruptions appearing in clusters of three to five, small and fine, indicate density. Single spots appearing plump and full indicate sparsity. Fever lasting one to two days before spots appear, with non-swollen eye sockets, normal urination and defecation, non-weak calves, non-puffy lips, non-blurred cheeks, and non-edematous muscles, is auspicious. Sparse eruptions with coolness in both exterior and interior indicate light toxin; if the pustules are distinct in size and clear without adhesion, it is appropriate to slightly administer formulas for supporting the Interior and resolving toxicity to aid eruption. During the filling and scabbing stages, if eruptions are too dense, adherent and blurred, indicating difficulty in emergence and persistent strong toxin, it is appropriate to administer larger doses of formulas for supporting the Interior and resolving toxicity to prevent complications such as sinking, pruritus, collapse, or black scabs. If the body is generally blurred but the face, throat, neck, chest, and back are sparse, clear, and distinct like pearls, it is treatable. Uniform color in rashes is favorable; mixed colors (two or three) appearing together are ominous. Vomiting followed by the appearance of spots which then stops is auspicious. Severe vomiting leading to deterioration indicates failure of Stomach Qi to expel toxin. Bright eyes with clear spirit, red and lively lips without dry whiteness, are auspicious. Eruptions appearing in two or three waves, fully emerging on the palms and soles by the third day, sparse on the head, face, and back, feeling firm to touch, with red halos at the base, varying sizes, plump and glossy, distinct red and white flesh, resembling bamboo shoots emerging from soil, and changing rapidly day and night, are auspicious. Spots appearing first on bony areas and being sparse are always auspicious. Spots appearing first on fleshy, non-bony areas and being dense are always ominous. Eruptions on the forehead are contraindicated, as this area is prone to excessive toxin invading the high Yang position. Alternating coolness and heat over several days, followed by spots appearing in pairs from the corners of the mouth and cheekbones, completing by the third to fifth day, is a sign of smooth progression. Observe: 1. The breadth of the forehead (Heavenly Sun); 2. The neck; 3. The chest and back; 4. The anus; 5. The chin (Earth Pavilion); 6. The umbilicus; 7. The pulse sites on both hands. If spots are sparse in these locations, it is auspicious.