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Seven days prior to the onset, chills indicate deficiency of the exterior; clenching of teeth (douya) indicates interior deficiency. Chills appearing seven days later indicate extreme Qi deficiency; clenching of teeth indicates extreme Blood deficiency. For Qi deficiency, Baoyuan Tang (Preserve the Origin Decoction) with added Guizhi (Cinnamon Twig) is used to assist the Yang aspect; for Blood deficiency, Baoyuan Tang with added Chuanxiong Rhizoma (Chuanxiong) and Danggui Radix (Danggui) is used to nourish the Yin aspect. If there is loss of consciousness, closed eyes with lack of spirit, delirious speech, mania and restlessness, picking at clothes seams, and incessant clenching of teeth, this signifies that Qi and Blood are about to be exhausted, akin to water that cannot be gathered again, and is incurable. If Baoyuan Tang had been administered early within the first seven days, it would still have been treatable.

If the face and eyes swell first and appear bright and lustrous five to six days after the eruption of smallpox, it is due to excess Blood and hyperactive deficient Yang, causing Qi to move recklessly in the muscle layer. If after seven days the Qi recedes and the toxin sinks inward, it becomes incurable.

After the toxin has cleared, the Wei Qi (Defensive Qi) is depleted and the Yuan Qi (Original Qi) further damaged, causing the Du Meridian (Governing Vessel) to contract and tighten, resulting in upward deviation of the eyes (jing shang diao). Loss of consciousness and lack of spirit are signs of incurability. However, if only the eyes are exposed without other symptoms, Baoyuan Tang with aged rice can be used to support the Stomach, benefit Qi, and consolidate the True Yuan. Cases presenting before the seventh day are definitely incurable.

The sound produced by Heart Qi striking the Lung emerges through the throat orifice, which resembles a tube. When smallpox erupts in the glottis, it is initially unnoticed. By the time the cutaneous pustules mature into pus, the internal pustules in the glottis also mature. If the toxin is severely congested, the airway narrows, causing the sound of airflow impact to be unclear, resulting in hoarseness and choking as if drinking water. The toxic smallpox obstructs the epiglottis, making swallowing difficult, causing fluids to spill into the airway. Since the airway rejects foreign matter, choking occurs. This differs from solid food with residue, which enters naturally without choking, unlike water invading the airway. Therefore, hoarseness and choking occurring after the seventh day may resolve spontaneously without treatment; why? Because the external eruptions vent out, allowing internal recovery. If these signs appear within the first seven days, they constitute adverse conditions (ni zheng), caused by Wind pathogen blocking the interstices and thick phlegm obstructing the airway, preventing the toxin from fully venting to the surface. Thus, ancient sages used Ganjie Tang (Licorice and Platycodon Decoction) prophylactically to clear the airway, which is indeed an excellent method.

When toxin vapors are excessive and Blood is weak, meridians may become disordered and bleed, manifesting as hematemesis or hematochezia, which are untreatable. Only nasal bleeding that transmits along the Du Meridian without invading the interior is harmless. If yang sores and smallpox toxins appear intermittently, it is termed "zou xie" (running leakage), leading to emptiness in the flesh and interstices, with the toxin having no fixed location. Blister formation occurs due to Blood insufficiency failing to carry the toxin back to its proper place, causing Qi-toxin to surge beyond its position, drawing fluid outward to form blisters. This condition is the most difficult to treat. Initially, the base is tender and red with scattered Blood, the pustule apex is white, thin, bright like crystal, and prone to enlargement. If such blisters are scarce, with active red bases and moist apices, or if normal pustules exist on the head, face, back, and chest, or if a few millet-sized normal pustules appear later, there is still hope. One should follow the previous prescription: Renshen (Ginseng), Chuanxiong, Danggui, Gancao (Licorice), Rougui (Cinnamon Bark), and Nuomi (Glutinous Rice) as guides, taken with Muxiang (Aucklandia) ground and wine/milk emulsion. If all erupt simultaneously regardless of size, with pale bases, it is incurable. If the pustules are not moist and appear gray and dull, it is incurable. If the physical signs are fixed by the ninth day, it is also incurable.