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The lips and mouth are the root of the muscles. They connect with the five zang organs, so observing them allows one to predict the auspiciousness or inauspiciousness of the condition in advance. When the toxin of smallpox erupts, if the lips, mouth, and tongue appear purple or black, or if the tongue is swollen, this indicates a syndrome of excessive excess heat and toxicity. If the color is red and vibrant without dryness, cracking, or parched redness, it signifies mild heat and scanty toxin. If the colors are yellow, white, red, or purple but not moist and lustrous, the prognosis is ominous (inauspicious). As for cases where vital qi is strong but high fever prevails, and white coating on the tongue extends to the moist area of the lips, this must indicate rotting of the stomach. In another scenario, where pustules on the lips are connected, while other pustules have not yet formed pus, these specific pustules turn yellow and mature first; this implies that internal ulceration has already occurred, making it difficult for external pustules to form pus. Furthermore, when qi and blood sink and toxins attack the lips and mouth, leading to erosion and ulceration, foul breath, gum ulceration, accumulation of yellow greasy coating on the tongue, and red spots on the nasal bridge, the condition is severe. Another type presents with a color resembling dried paste, where the flesh rots and smells foul, deteriorating by one fen per day and one cun per two days; this is named "Zou Ma Gan" (Walking Horse Gangrene), which is incurable. If the smallpox rash has not yet faded, but the lips and mouth are dry, red, and gritty, with red cheeks and purple lips, this is a sign that Lung Abscess (Fei Yong) is about to form; treatment should focus on detoxification and clearing the lungs. If accompanied by phlegm, wheezing, and coughing, Shen Su Yin (Ginseng and Perilla Decoction) should be the primary formula. If the physician treats skillfully, this condition can still be revived.

The orifice of the Spleen connects to the mouth, and its brilliance manifests in the lips; thus, the lips and mouth are the external indicators of the Spleen. At the initial stage of fever from sores and rashes, if the breath in the mouth is harmonious and the lip color is red and lustrous, it is auspicious. If there is dry mouth and cracked lips, the toxin must be severe, requiring urgent release of the exterior; otherwise, dense sores will emerge on the lips and mouth, forming yellow pus before other sores erupt, scabbing over and becoming dark and depressed before other sores heal, with peeling lip skin, gradually progressing to vomiting food, choking on water, lethargy, and death. If facial sores are swollen and suppurating, while sores on the lips crack into blocks and become dry and splintered, the condition is heavy. If sores erupt too densely and the mouth emits a foul odor, this indicates deterioration of the zang and fu organs, causing the odor to emanate from the mouth. If the sores are about to worsen and the lips retract upward, it signifies the exhaustion of the Spleen. If sores tear downward, it is called "Yu Kou" (Fish Mouth). Saliva in the mouth that is sticky like glue indicates the exhaustion of Spleen fluids, which is also incurable. Additionally, if sores appear on the lips and mouth accompanied by hoarseness, this is Hu Huo Syndrome (Fox-Hu Syndrome); if not treated urgently, it often leads to death. However, why is lip swelling contraindicated during smallpox? Because extreme swelling that does not subside requires vigilance against white lips and stomach rot, where the smallpox toxin would ulcerate internally without emerging externally. Why is an open mouth feared? Because an open mouth indicates Spleen failure, requiring vigilance against qi leakage leading to convulsions and tetany. However, opening the mouth to breathe comfortably due to nasal congestion and difficulty breathing is not included in this category. If after ten days the mouth remains open and teeth become brittle, it signifies exhaustion of the Spleen and failure of the Kidney, which is incurable.