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When the smallpox rash first begins to manifest with fever, it is not yet clear whether the prognosis is favorable or unfavorable. It is appropriate to administer Shengma Tang (Cimicifugae Decoction), Bosu Tang (Perilla Decoction), or a decoction of Baijiu (White Wine), Jiangzhi (Ginger Juice), and Ziye (Perilla Leaf). The medicine should be taken when slightly warm. If it is indeed smallpox, its characteristics will become apparent. Subsequently, use red cotton paper rolled into a wick, dipped in sesame oil, lit as a lamp, and used to illuminate the child's entire body. Observe the skin for internal structures resembling branches, roots, sprouts, or flower stamens of varying sizes. A reddish and vibrant color indicates a good prognosis; do not administer medication indiscriminately. If the ears, eyes, and nose are narrow like needle tips, lacking luster and branch-like formations, it indicates a poor prognosis; again, do not administer medication, as this is not erysipelas (Dan Du), and medication would be ineffective.

Once the smallpox rash has emerged, one must first inquire about the quantity of food and drink consumed over the preceding days and whether bowel movements and urination are regular. Then, observe the density, color, and surrounding halo of the pustules. If fever persists for six to seven days while the patient's spirit and essence remain clear, the pustules will likely be sparse, pointed, round, vibrant, and moist. If fever lasts only two to three days, the condition is manageable. However, if fever occurs within one to two days accompanied by turbid spirit and coarse breathing, the pustules will be dense. Although they may appear distinct and moist, even if countable, they may exhibit sharp protrusions. Survival beyond fourteen days indicates stability. If the pustules are dense, dark in color, flat, sunken, and lack defined pores, medication is unnecessary; the patient will likely not survive beyond five days.

Additionally, there is a type of pustule that is not round, appears dark and dull, prevents eating, involves high fever, and presents with white, rotting, foul-smelling sores in the mouth, termed "internal collapse" (Nei Kui). This condition is difficult to survive past seven days. Generally, anorexia results from Qi stagnation and obstruction. Baoyuan Tang (Preserve the Origin Decoction) can be modified with Shan Zha (Crataegus) and Mu Xiang (Aucklandia). If the color is purple, it indicates blood stasis and Qi deficiency; add Huang Qi (Astragalus) and Chuan Xiong (Ligusticum) to the base formula. Pustules that are not pointed indicate weak Qi; double the dosage of Ren Shen (Ginseng). If the pustule fluid is clear and the apex is insufficient, toxin accumulation is inevitable. If this occurs before the seventh day, the toxin is manifesting on the exterior; if after the seventh day, it is manifesting in the interior. For interior manifestation, modify Baoyuan Tang with Sheng Jiang (Fresh Ginger), Nuo Mi (Glutinous Rice), and Guizhi (Cinnamon Twig). If the pustules turn black towards the interior, use Huang Lian (Coptis), Jing Jie (Schizonepeta), and Niu Bang Zi (Arctium Seed). Fever recurring on the seventh day is termed "steaming pulp" (Zheng Jiang). Fever recurring on the tenth day indicates residual toxins; use Lianqiao Baidu San (Forsythia Detoxification Powder). Fever recurring on the fourteenth day indicates exterior deficiency; use Bazhen Tang (Eight Treasures Decoction). Diarrhea occurring before the seventh day requires modifying the base formula with Mu Xiang, Huang Lian, and Dou Kou (Cardamom). Diarrhea occurring after the seventh day with insufficient pustule fluid requires Baoyuan Tang. Abdominal pain due to food stagnation is treated with Baoyuan Tang modified with Shan Zha and Chen Pi (Tangerine Peel). If the disease burden is seventy percent smallpox and thirty percent miscellaneous symptoms, once the smallpox resolves, the remaining symptoms will disappear. Carbuncles caused by residual toxins appearing on the limbs are mild; those on the head, face, chest, and abdomen are severe. Urgently puncture with a silver hairpin, apply external powder of Zhen Zhu Mo (Pearl Powder), Xue Jie You (Dragon's Blood Oil), and Yan Zhi (Rouge), and secure with cotton paper. Internally, administer Baoyuan Tang modified with Dang Gui (Angelica Sinensis), Hong Hua (Safflower), Niu Bang Zi, and Lian Qiao (Forsythia). If eye pathology exists, treatment must wait until the smallpox lesions have fully receded. Eye treatments involve Man Jing Zi (Vitex Fruit) and Mi Meng Hua (Blindania Seed). For carbuncles and sores, prioritize detoxification; if no pus forms, add Guan Gui (Cinnamon Bark). Chills and teeth grinding are treated with Baoyuan Tang modified with Mu Xiang. Generally, treating within the first fourteen days using modified Baoyuan Tang ensures success without failure.