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Smallpox primarily manifests on the face, as the essence of the five Zang organs ascends to the head and face. Therefore, if sores on the body itch and are scratched open, it does not cause major harm; however, the facial area must not be touched or damaged in any spot. If a scratch occurs between the eyebrows, eyes, nose, or cheeks, this indicates Lung Heat (Lung Re: Pathogenic heat affecting the Lung system). One should urgently use herbs such as Gancao (Licorice Root), Jiegeng (Platycodon Root), and Niubangzi (Arctii Fructus) to resolve it. If the itching stops immediately, it is a favorable omen. If the itching persists, the condition will spread progressively, Qi (Vital Energy) will leak, and the itching will intensify, inevitably leading to death from extensive scratching of the entire face. Furthermore, during the stage of eruption and pus formation, the sores on the forehead may appear as if scalded by fire or boiling water, ulcerating and destroying the skin until no intact skin remains. The same may occur on the sides of the cheeks. Without being scratched, they break open spontaneously. They will gradually ulcerate and form dry, blackened crusts. As fluids dissipate, the appearance resembles scabs but is not true scabbing. This collapsing momentum cannot be controlled, inevitably leading to death from the exhaustion of Yang Qi (Yang Qi: The active, warming, and defensive energy of the body). Additionally, at the initial stage of pus formation, when scabbing is difficult, if the sores on the face have not yet fully suppurred, but suddenly the tip of the nose dries first with an orange-like color, or the sores at the glabella dry and turn black spontaneously, or the sores above the ears retract spontaneously, or the sores on the lips become dry and black, or the sores on the cheeks dry and flatten like a cake, these are all termed "Dao Ye" (Inverted Scabbing), which is a sign of death. It must not be mistaken for normal scabbing.

In the human body, all Yang meridians ascend to the head and face, while all Yin meridians return from the head and chest. Thus, the head and face belong to Yang, and smallpox also belongs to Yang. Like attracts like; therefore, from eruption to scabbing, the process begins at the head and face. Ascending, generating, floating, and lengthening are the nature of Yang. When smallpox erupts, if the head and face swell gradually, it aligns with the nature of ascending and generating, so there is no need for fear. As long as the pustules are distinct, red, and vibrant, with luster, robustness, and moisture, after they naturally form pus, the toxin will transform and scab over, and the swelling will gradually subside. If the sores adhere and merge into patches, appearing blurred and cake-like, as long as they are red, vibrant, and moist, the throat is clear, the chest and diaphragm feel comfortable, and diet is regulated, complications will not arise. However, if the color is grayish-white or greenish-yellow and dry, death ensues. If the head and face are swollen but the eyes remain open, the toxin is shallow and the disease is mild. If the eyes are closed, the toxin is deep and the disease is severe. If the sores mature, swelling subsides, and the eyes open, it is auspicious. If swelling subsides and eyes open before pus formation, this is termed "Xian" (Collapse/Depression), which is incurable. Furthermore, if the head and face swell prematurely before spots appear, the toxin is scattered in the skin and hair follicles and cannot penetrate the muscles to emerge. If the head and face swell prematurely just before eruption, Qi floats upward and muscle pores relax, preventing the pustules from rising and forming pus. This results from infection with epidemic pathogenic Qi (Epidemic Qi: Pathogenic factors capable of causing epidemics), named "Da Tou Wen" (Great Head Plague). Its toxicity is most fierce. Upon recognizing the signs, one must urgently employ clearing, resolving, penetrating, and supporting methods to seek a slim chance of survival.