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When the smallpox (or variola) presents with mild fever, or alternating chills and fever, and after several days the spots appear, if they are coarse, plump, red and vibrant in color, feel rough to the touch, and have a solid root within the flesh, it is auspicious. If the fever lasts only briefly before all spots erupt simultaneously, or if they first appear on the forehead and feel rootless upon palpation, it is ominous. If there is slight swelling of the muscles, resembling piled millet grains without distinct individual spots, this indicates Qi stagnation and Blood coagulation, with toxic factors郁结 (accumulating). If the initial red spots gradually turn black and become hard as stone, this signifies that the muscle tissue has already deteriorated; due to deficiency of Qi and Blood, the body cannot carry the toxin out, leading instead to sinking and伏留 (retention). If the center of the spot is black and sunken while the surrounding edges protrude and contain pus, this indicates that Blood follows the toxin but Qi fails to exert its controlling function. If the center contains pus while the surrounding edges are dry, sunken, and scorched black, this indicates that Qi attaches to the toxin to emerge, but Blood fails to follow as its guide. If the top of the sore bears white pus and ruptures spontaneously into ulceration, this is due to insufficient Qi and Blood and deterioration of the skin. If it forms blisters that are fluid-filled and easily broken, this indicates concurrent Fire and Dampness, with Qi deficiency failing to consolidate and bind. If it forms blood blisters that are purple and easily broken, this indicates reckless movement of Heat in the Blood, which cannot adhere to Qi. If the sore head resembles a needle hole with serum oozing out, this signifies that Wei Qi (Defensive Qi) has failed and body fluids are escaping externally. All these conditions are considered untreatable.

Wei Qi (Defensive Qi) circulates in the Yang aspects during the day and in the Yin aspects at night; circulation in Yang leads to wakefulness, while circulation in Yin leads to sleep, which is the normal state of humans. When sores and rashes present with fever accompanied by lethargy and swelling, it is generally because the Heart governs Heat and the Spleen governs heaviness/stagnation; since the Heart receives Qi from the Spleen, fever and drowsiness occur, which is a common presentation. However, if the patient tosses and turns restlessly, it indicates internal Heat, which inevitably leads to variations of sinking and retention. Sleeping face down indicates interior Heat. In general, if the patient sleeps peacefully throughout the course of the sores and rashes, it is auspicious. This is because strong Qi and Blood allow Ying (Nutritive) and Wei (Defensive) Qi to flow smoothly, causing the pathogenic factor to exit via the exterior rather than remaining in the interior; thus, the Spirit (Shen) is calm. When the Spirit is calm, the will is settled, allowing for peaceful sleep. Conversely, if Qi and Blood are weak and Ying and Wei Qi are stagnant and sluggish, the pathogen remains in the interior rather than the exterior, generating internal Heat. Since the Heart dislikes Heat, Heat disturbs the Spirit, making it restless; when the Spirit is restless, the will is unsettled, leading to irritability, confusion, delirium, and insomnia. Furthermore, if after the eruption of smallpox, toxins remain latent in the middle Jiao, causing the loss of Spirit and depletion of Qi, resulting in rigid lying like a corpse, unresponsiveness to calls, and ignorance of food and drink, this is termed "dead smallpox" and should not be discussed under the category of peaceful sleep.