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There are children in the world who are born with a broad and obese constitution, seemingly having an abundance of Xueqi (Blood and Qi). Why do they suffer from empty pustule sacs when contracting smallpox, failing to fill with pus and suppurate, leading to death on the eighth or ninth day? This is because congenital Yuanqi (Primal Qi) cannot be constrained by physical form, nor can Xueqi be stagnated by material substance. Those whose bodies are thin and small but possess abundant Yuanqi will naturally have their smallpox erupt, fill, and succeed. Conversely, those whose bodies are large and obese but have weak and inferior Yuanqi will inevitably experience dryness and difficulty in growth. Therefore, treating smallpox requires observing the patient's Yuanqi, not judging based on physical appearance. Moreover, smallpox involves different meridians and locations, varying numbers and sizes, differing Qi movements and seasonal timing, as well as gains and losses in care and nourishment; how can it be judged solely by physical form?

Thus, if the smallpox follows the correct meridians, presents with sparse and clear lesions, aligns with favorable Qi movements, receives appropriate care, and originates from shallow toxin levels, then even a thin and small individual with solid Yuanqi will not be harmed, and even one with weak Yuanqi may survive. However, if the smallpox invades incorrect meridians, presents with dense spots, occurs during adverse seasons, involves improper care contrary to norms, and stems from intense inherited toxin levels, then even an obese individual with strong Qi may die, let alone one with deficient Xueqi and Yin. Furthermore, those with black sores have firm bones and hard flesh, with Qi secured internally where bone dominates flesh, indicating a generally auspicious outcome for smallpox. In contrast, those who are obese and pale have brittle bones and loose flesh, with Qi residing superficially where flesh dominates bone, indicating a generally ominous outcome. This is because the Kidney governs bones, and smallpox is considered a toxin of the Kidney.

The *Classic* states: "In spring and summer, Yang Qi is above, and human Qi is also above; in autumn and winter, Yang Qi is below, and human Qi is also below." Therefore, when smallpox erupts in spring and summer, Xueqi follows the ascending Yang Qi and moves rapidly; when it erupts in autumn and winter, Xueqi follows the descending Yang Qi and moves slowly. Smallpox primarily manifests on the head and face. Spring and summer correspond to the energy of generation, while autumn and winter correspond to the function of storage. Thus, it is said that spring and summer are favorable (Shun), while autumn and winter are unfavorable (Ni). However, there are cases where spring and summer are ominous and autumn and winter are auspicious, depending on the strength of inherited Qi and the depth of toxin exposure, which then rely on seasonal timing. It is also stated that "spring pustules fail to dry, summer lesions become black and sunken, autumn presents with macules, and winter presents with rashes," all of which are unfavorable signs, discussed in terms of the Five Zang Organs' correspondence to seasonal timing. Although black sunken lesions occurring in winter are still not a good omen, this must be understood. One should retain the general principles but not apply them rigidly, as there are exceptions and errors.