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The smallpox (douchuang) belongs to the Yang syndrome. Its appearance in spring and summer is a favorable course (shun), while its appearance in autumn and winter is an unfavorable course (ni). The emergence of sand-rash (shasha) in spring, black depression (hei xian) in summer, pustules (nong pao) in autumn, and rashes throughout the four seasons are considered favorable courses. Conversely, if pustules appear in spring, black depression in summer, and rashes in autumn and winter, these are all unfavorable courses. For unfavorable courses, even without medication, how could immortal pills restore life? It is also said that smallpox appearing first followed by mixed rash is a favorable course; rash appearing first followed by mixed smallpox is also a favorable course. If smallpox appears first followed by blisters, a large number indicates a favorable course, while a small number indicates an unfavorable course. If blisters appear first followed by mixed rash, a small number is favorable, and a large number is unfavorable. If blisters appear first followed by mixed rash, it is an unfavorable course. If the sores have turned black but suddenly discharge pus, blood, and scabs, it is a favorable course; if food and milk cannot be digested, it is an unfavorable course. Generally, favorable courses indicate auspiciousness, while unfavorable courses indicate ominous signs. There are cases where the timing follows the seasons but internal dangerous complications lead to death; there are also cases where the timing opposes the seasons but the color, shape, and symptoms of the smallpox are mild and sparse, leading to survival. Such judgment methods are relied upon for the survival of infants and young children.

When smallpox first emerges, one must first distinguish the locations. These locations refer to the Heavenly Court (Tianting, forehead) and the Earthly Pavilion (Dige, Chengjiang point at the chin). If the sores are dense in a certain location, the toxin is severe; if sparse, the toxin is light; if absent, the respective meridian has no toxin. For instance, the top of the head, forehead, back, waist, and Weizhong (BL40) belong to the Taiyang Meridian; the face, nose, cheeks, and jaw belong to the Hand and Foot Yangming Meridians; the throat and dorsum of the hand belong to the Lung Meridian; the chest and diaphragm, tongue, and heart area belong to the Heart; the hypochondrium and genitalia belong to the Liver and Gallbladder; the four limbs belong to the Spleen. Mild cases present with pointed, round, and full sores, grayish-yellow color, rough skin, ability to eat, robust physique, and no other symptoms, which is auspicious. Severe cases present with hollow, depressed, itchy, densely clustered, floating red sores, swollen flesh, non-distended sores, closed eyes, hoarse voice, and inability to eat; even with a lifespan hard to buy for a thousand gold, what use are miraculous medicines? It is also said that if smallpox turns gray first on the head, face, chest, and back, appearing around the eighth or ninth day is a favorable course; if it appears first on the feet, knees, waist, and legs, it is an unfavorable course. Such direct indications are amazingly accurate.

The color of the smallpox should be lustrous on the outside, indicating that there is no accumulated toxic stagnation in the five zang organs and beneath the skin, which is auspicious. If the color is mixed with black and gray, dry with a scorched apex, and moist only at the base on the outside, this indicates toxic stagnation in the zang-fu organs that cannot be vented outward, which is ominous and incurable.

Regarding the morphology and symptoms of smallpox: if eruptions occur two or three times within one or two days, emerging successively, with only three to five sores behind the ears, beside the nose, and under the chin, having red, vibrant, moist pits, slightly raised, or accompanied by alternating chills and fever, emerging and growing successively, and by the fifth to seventh day, the skin becomes rough, the blisters fill with fluid, the color resembles gray wax, and the tips are round, this is auspicious. However, if within one or two days, during intermittent fever, they all erupt at once like mosquito or flea bites, with convulsions, dry red scorched tops, resembling snake skin or silkworm shells, purple and swollen with itching, or swelling then suddenly subsiding, or sudden swelling, with fleshy sores that do not distend, this is ominous.