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In general, before the smallpox lesions erupt, there must be a fever for three days to allow the pathogenic factors to vent outwards, which is an auspicious sign. If fever lasts only one day before the initial signs of eruption appear, it is an inauspicious sign. If the fever lasts one and a half days, less than two days, it is a perilous condition.
This illustrates how to judge auspiciousness or inauspiciousness based on the three-day fever period. Next comes the appearance of the initial marks (early stage of eruption). If they emerge successively within three days, are sparse, round, and pointed, extending down to the feet, this constitutes complete eruption without other symptoms and with normal appetite, which is an auspicious and favorable condition. If the erupted lesions are dense like silkworm eggs or mosquito bites but not hard to the touch, yet accompanied by malignant symptoms, death is inevitable; this is an inauspicious and adverse condition, untreatable. If the circular halos of the lesions have formed but appear dry, red, and lacking moisture, this indicates the initial interaction between Qi and Blood, where the outcome is undetermined. One should employ tonification and support methods. When Qi and Blood harmonize, the lesions will naturally suppurate. This describes the judgment of auspiciousness or inauspiciousness three days after eruption begins.

By the fifth or sixth day, the lesions should fill with pus (suppuration). The skin of the lesions should be thick, smooth, round, and waxy-white in color, indicating that Qi transformation promotes fluid movement and toxins resolve spontaneously; this is auspicious and favorable. If pus fails to form and toxins do not resolve, the lesions become dry, dense, itchy, gray, and sunken; this signifies that Blood cannot adhere to Qi, representing an inauspicious and adverse condition leading inevitably to death. If Qi and Blood have interacted but pus formation is insufficient, with colors being partially moist, the condition is perilous, representing a mixed prognosis of partial auspiciousness and partial inauspiciousness. It is appropriate to use Baoyuan Tang (Preserve the Origin Decoction) added with Guizhi (Cinnamon Twig) and Baizhu (Atractylodes Macrocephala Rhizome) to promote pus generation. Survival depends on the presence of pus; absence leads to death. This describes the prognosis three days into the suppuration phase.

During the scabbing phase, if the lesions turn gray starting from the head, face, and back, it is auspicious and favorable. If they turn gray starting from the feet and inner thighs, it is adverse and inauspicious. This refers to the prognosis on the ninth, tenth, or eleventh day during scabbing. By the twelfth to fourteenth or fifteenth day, if the toxin has receded and the sores should shed their scabs, this indicates that Qi and Blood are substantial and toxins are completely resolved, which is auspicious and favorable. There are cases where scabs do not fall off as expected, or where purulent odor forms crusts, commonly called "external return smallpox"; this is incorrect. It actually results from deficiency of Qi and Blood and incomplete resolution of toxins. Healing occurs only when Qi and Blood reach harmony and toxins dissipate.

Generally, children vary in innate constitution (deficiency or excess), and care differs between wealthy and poor families. Children may be strong or frail, and improper nursing can lead to exacerbation of excess conditions or worsening of deficiency conditions. This stems from parents' excessive love and intervention, unaware of the risks of relapse. Consequently, fever may last three to five days before lesions form, and eruption may take eight to nine days. Complete eruption is confirmed only when lesions appear on the feet. After completion, blood scabs form. Alternatively, around the eighth or ninth day, pus-filled pits may contain red spots. If the weather is warm, eruptions occur easily; if cold, eruptions are delayed. Therefore, one cannot judge strictly by days alone. Recovery occurs only when Ying and Wei (Defensive and Nutritive Qi) are harmonized and no other symptoms persist, allowing healing to proceed as scheduled.