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[Shun Hou (Favorable Prognosis)] The occurrence of smallpox in spring and summer is favorable. It is favorable if convulsions and twitching occur first, followed by the eruption of pustules. It is favorable if fever occurs first, subsides, and then pustules erupt. It is favorable if dietary intake remains normal. It is favorable if urination and defecation remain normal.

[Ni Hou (Unfavorable Prognosis)] The occurrence of smallpox in autumn and winter is unfavorable. In spring, the appearance of purulent blisters indicates Metal overcoming Wood. In summer, black sunken lesions indicate Water overcoming Fire. In autumn, the appearance of macules indicates Fire overcoming Metal. In winter, the appearance of papules indicates Earth overcoming Water. Hematochezia or diarrhea, and indigestion of milk and food indicate Spleen deficiency. During the active eruption phase, vomiting and diarrhea occur; wind pathogen attacks the cheeks, mandible, neck, and eyelids; or the chest protrudes high, the face swells with a sunken nose, eyes are closed, and teeth are clenched; or there is black qi at the nostrils. Muscles turn black. The complexion becomes cyanotic and black. Or, due to vomiting and diarrhea causing internal deficiency, the toxin sinks inward. After eruption, spontaneous sweating leads to ulceration. Or, exposure to wind pathogen causes inverted crusts (sunken pustule tops) that fail to rise. Diarrhea persists, pustules flatten like cakes, dry thirst and dysuria occur, voice becomes hoarse. Medication is aspirated into the throat, wheezing does not cease, pustules are all scratched open, emitting an unbearable foul odor. Eyes are closed, gaze is dark, spirit seems lost. Head and face swell, feet are cold up to the knees. Frequent straining (resembling the effort of defecation), with no distinction between pustule color and surrounding skin. After eruption, fever and heat in the feet do not subside; after eruption, restlessness and confusion persist. Post-recovery convulsions occur; before the expected crusting stage, sudden blackening, darkening, or purplish discoloration appears.

[E Hou (Malignant Prognosis)] Pustules erupt but then disappear. Sudden severe diarrhea accompanied by thirst. After eruption, continuous delirium. Or, black-purple discoloration hidden deep within the muscles, indicating severe toxicity. In severe cases, pustules appear in the five Zang organs and the throat. The lesions do not form granules, resemble coagulated blood, cause pain, and black crusts produce no pus or blood; this indicates death. Or, if these signs are seen and medication is used to resolve the toxin, but the toxin instead sinks inward, this indicates death. Eyes open but abdomen distended, with foul breath from the mouth; this is incurable. Constipation of both stool and urine, blackened skin, closed eyes, and hoarseness indicate death. Stomach heat causing jaundice, body color like orange peel, accompanied by diarrhea; this indicates death.

Smallpox Eruption: First to Second Day
[Favorable] Initially, bleeding points appear as pale red and lustrous. By the second day, they resemble millet grains, appearing around the mouth, nose, cheeks, ears, and the tip of the nose. The initial emergence of two or three pale red and lustrous spots is a sign of favorability. Favorable cases heal spontaneously without medication, as Qi is upright, Blood flows smoothly, and the toxin is mild, preventing it from wreaking havoc.

[Unfavorable] The shape resembles a patch of silkworm eggs or red dots on hemp cloth. Black papules initially appearing on the Tian Ting, Si Kong, Tai Yang, Yin Tang, and Fang Guang areas are signs of unfavorability. Unfavorable cases are difficult to treat, indicating original Qi deficiency and Qi-Blood stagnation. The pathogenic toxin is too excessive, invading Yang regions, overwhelming the body's resistance.

[Critical] Areoles take shape, dry and red with little moisture. Although dense, the pustules are still red, lustrous, and granular; this is critical. In critical cases, although the toxin is strong, original Qi is still sufficient, so alarm is unnecessary. One should use formulas to tonify original Qi with a slight addition of detoxifying herbs, ensuring the strong toxin does not damage righteous Qi.

Smallpox Roundness: Second to Third Day
[Favorable] Qi overflows and adheres to Blood; the lesions are full and smooth. By the third or fourth day, the bases are round and complete, indicating abundant original Qi. When Qi is abundant, Blood adheres, and both follow their proper paths; this is favorable. Favorable cases heal spontaneously.

[Unfavorable] Qi is stagnant, Blood coagulates; the lesions are withered and lack luster, bases have no areole, Qi separates from Blood; this is unfavorable. This indicates insufficient intersection of Qi and Blood, allowing toxins to invade internally opportunistically.

[Critical] The apex is sunken and not full, yet smooth and spirited; the base is still round, but only the apex is sunken, indicating difficulty in Qi-Blood filling; this is critical. Use Bao Yuan Tang (Preserve the Origin Decoction) plus Chuanxiong Rhizoma (Chuanxiong) and Cinnamomi Ramulus (Guizhi) to assist Spleen and Stomach Qi and Blood, ensuring safety.

Smallpox Color and Shape: Fourth to Fifth Day
[Favorable] Qi is full, Blood is nourished, bright and lustrous, indicating vigorous Qi and Blood and shallow toxin penetration. The shape is smooth, varying in size; this indicates harmony of Qi and integration of Blood, which is favorable and heals spontaneously.

[Unfavorable] By the fourth or fifth day, lesions are dense like blisters, purple-black and dry-red, resembling silkworm eggs, or black-sunken purple blisters; all are unfavorable. Unfavorable cases are hard to treat due to separation of Qi and Blood and internal attack by pathogenic toxins.

[Critical] By the fourth or fifth day, bases have risen, but the color is dull and unclear; this is critical. Blood is good, but Qi is weak, and their intersection is indistinct. Use Bao Yuan Tang plus Atractylodis Macrocephalae Rhizoma (Baizhu) and Chuanxiong Rhizoma (Chuanxiong) to support Defensive Qi and Nutritive Blood; the color will naturally become bright.

Smallpox Rising and Fulfillment Phase
[Favorable] By the fifth or sixth day, Qi is abundant and Blood is nourished internally; pustules should be full and rising externally. This is favorable and heals spontaneously without medication.

[Unfavorable] By the fifth or sixth day, pustules remain dry, dense, and non-rising; apices are gray-white, purple-black, or water-filled, itchy, and collapsed; this is unfavorable. This indicates Qi and Blood weakness leading to internal sinking of toxins and external peeling. All such cases are untreatable.

[Critical] Between the fifth and sixth days, pustules have risen but are white and lacking luster; this is critical. This indicates excess Qi and deficient Blood. Use Bao Yuan Tang plus Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Cinnamomi Ramulus (Guizhi), and Paeoniae Radix Alba (Baishao) for recovery.

Smallpox Pus Fullness: Seventh to Eighth Day
[Favorable] By the seventh or eighth day, pustules are full of pus and complete, with green-yellow luster; the toxin is eliminated, and the work of Qi and Blood is accomplished. This is favorable and requires no medication.

[Unfavorable] By the seventh or eighth day, pus is insufficient; this is the time of Qi and Blood exhaustion, making medication ineffective; this is unfavorable.

[Critical] By the ninth or tenth day, color is red-yellow and moist, but pus is slightly insufficient; this indicates weak Qi and a critical state. Use Bao Yuan Tang plus Zingiberis Recens Rhizoma (Shengjiang) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify and assist, ensuring the pus matures fully.

Smallpox Blood Exhaustion and Pus Return: Eleventh to Twelfth Day
[Favorable] By the twelfth or thirteenth day, Qi is regulated, Blood is exhausted (consumed by the process), toxin is resolved, pus returns, and luster gradually收敛 (converges); this is a natural favorable prognosis.

[Unfavorable] By the twelfth or thirteenth day, Blood is pale and pus thin, Blood coagulates and Qi stagnates; thus, toxin does not disperse, pus does not return, leading to extreme withering and peeling; this is an unfavorable prognosis, worthy of fear.

[Critical] By the twelfth or thirteenth day, Blood is exhausted, pus is mature, but moisture does not converge; this indicates internal deficiency and a critical state. Use Bao Yuan Tang plus Poria (Fuling) and Atractylodis Macrocephalae Rhizoma (Baizhu) to aid convergence and crusting.

Smallpox Crusting: Thirteenth to Fourteenth Day
[Favorable] By the thirteenth or fourteenth day, Qi and Blood return to their origins, toxic vapors dissipate, mature pus forms crusts; this represents perfect transformation and healing, which is favorable.

[Unfavorable] By the thirteenth or fourteenth day, toxin has not expelled; although crusts form, various pathogens still manifest; this is unfavorable.

[Critical] Within the thirteenth to fourteenth days, during the formation of mature crusts, miscellaneous symptoms persist; this requires temporary adjustment and harmonization. Do not act lightly; this is the essence of management.

Smallpox Restoration: Fourteenth to Fifteenth Day
[Favorable] By the fourteenth or fifteenth day, Qi and Blood are perfect, crusts fall off, scars are clear, spirit is refreshed; this is favorable.

[Unfavorable] By the fourteenth or fifteenth day, crusts have not fallen, delirium and mania persist, chills occur, carbuncles and miscellaneous diseases remain; this indicates loss of vitality and is unfavorable.

[Critical] By the fourteenth or fifteenth day, crusts fall but appetite is low, thirst and irritability persist; this is residual toxin and is critical. Use Si Jun Zi Tang (Four Gentlemen Decoction) plus Coptidis Rhizoma (Huanglian), Arctii Fructus (Niubangzi), and Forsythiae Fructus (Lianqiao) Detoxification Decoction type formulas to treat; recovery is possible.