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Smallpox (or variola) presents in three patterns: Shun (Smooth/Favorable), Ni (Rebellious/Unfavorable), and Xian (Dangerous). Practitioners must understand these. Shun represents a favorable omen. Ni represents an ominous omen. Xian represents an omen of regret and difficulty. If the pattern is Favorable, treatment is unnecessary; intervening may lead to unfavorable outcomes. If the pattern is Unfavorable, laboring with treatment is futile; what benefit would it bring? However, for Dangerous patterns, treatment is indicated.

The uneven eruption of lesions arises from the uneven distribution of Qi and Blood. When Qi and Blood are abundant, toxins are easily resolved, manifesting as a Smooth pattern; this heals spontaneously without treatment. If Qi and Blood are deficient, toxins are difficult to resolve, manifesting as an Unfavorable pattern; here, even treatment yields no benefit. Only when Qi and Blood are slightly weak, such that toxins cannot be instantly cleared and the vital energy in the Middle Jiao is not firmly established, is it necessary to apply tonifying and supporting methods. As the saying goes, "Assistance leads to prosperity; lack of assistance leads to demise." Furthermore, if lesions are sparse and toxin load is low, pathogenic factors cannot overcome healthy Qi; the Qi mechanism harmonizes naturally, and the disease course proceeds smoothly, requiring no medication. If lesions are dense and toxin load is high, pathogenic factors and healthy Qi contend equally; the Qi mechanism becomes pathological, and the disease course becomes dangerous. In such cases, it is appropriate to suppress pathogens and support healthy Qi, rapidly depriving the pathogen of its hold so it does not become a thief to healthy Qi. If lesions are densely uniform but the toxin burden is extreme, healthy Qi cannot overcome pathogens; the Qi mechanism becomes disordered, and the disease course becomes rebellious. Even skilled practitioners can only wait helplessly for death. Thus, do not treat Smooth patterns; prioritize treating Dangerous patterns; do not treat Unfavorable patterns. The rationale is evident here.

There are Five Good Signs and Seven Bad Signs in smallpox; practitioners should be thoroughly familiar with them. What are the Five Good Signs? First, normal diet and appetite; second, regular bowel movements and urination; third, lesions are red, vibrant, firm, and solid; fourth, pulse is calm, body temperature is cool, and hands and feet are relaxed; fifth, voice is resonant, and movement/rest is peaceful. These five signs need not all be present simultaneously; if two or three are observed, recovery is naturally assured. What are the Seven Bad Signs? First, irritability, restlessness, delirium, and mental confusion. Second, vomiting, hiccups, diarrhea, and inability to eat. Third, lesions turning cyanotic, dry, black, sunken, pruritic, collapsed, or ulcerated. Fourth, premature swelling of the head and face, nasal congestion, closed eyes, and cracked lips. Fifth, chills, teeth grinding, hoarse voice, and dark complexion. Sixth, ulceration of the throat and tongue, vomiting upon eating, and choking upon drinking. Seventh, abdominal distension, panting, and cold extremities. Within the Seven Bad Signs, the appearance of any single symptom indicates an incurable condition. Beyond the Seven Bad Signs, if there are blood blisters over the whole body, stabbing pain in the heart and abdomen, lesions failing to erupt (sunken inward), hard nodules resembling thorns, hematuria and bloody stools, or picking at empty air (involuntary grasping movements), these are signs of rapid demise.