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When the smallpox/rash erupts vigorously, it is due to blood heat stagnating on the surface of the skin. By the third day or fifth to sixth day, pus and blood scabs should form, leading to recovery. If the rash does not form pus and blood scabs after six or seven days, this is because the pathogenic toxins (Du Wei) are abundant and penetrate from the interior to the exterior. If not resolved promptly, the toxins may re-enter, causing the lesions to collapse (Dao Ye), for which Zhuwei Gao (Pig Tail Ointment) is indicated. After carefully examining the pulse and external manifestations, purgative methods may be applied. If the blood heat persists for five to seven days without forming scabs, accompanied by the ability to eat but with panting, thirst, abdominal distension, lethargy, delirium, and constipation, Chengqi Tang (Cassia Decoction) combined with Chuanhuang San (Chuanhuang Powder) should be used to purge. If there is thirst, fever, red face, mental restlessness, difficulty in urination and defecation, or severe vomiting, diuresis should be promoted, and Tongguan San (Passing the Barrier Powder) is appropriate. Furthermore, if the rash has erupted and stabilized but defecation remains blocked, and the pus from the lesions does not dry up, Niuhuang Dan (Calculus Bovis Pill) is indicated. In cases where the rash syndrome appears but has not yet erupted, with stomach heat manifesting as mild fever, coarse breathing, abdominal fullness, reddish and difficult urination and defecation, palpitations during sleep, irritability, thirst, dry mouth, and a deep, large, slippery, and rapid pulse, this indicates abundant toxins that cannot be vented; Lidu Wan (Toxin-Expelling Pill) should be used to purge. When there is no internal stagnation and the Ying (Nutritive) and Wei (Defensive) Qi circulate normally, the rash will erupt naturally. These are all indications for purgation. Conversely, if the lesions are black and depressed, with spontaneous diarrhea and abdominal distension, this is a deficiency-cold syndrome requiring warming treatment, and purgatives must not be used.

If the smallpox eruptions appear and then disappear, or if there is severe diarrhea with thirst, these conditions arise because external medications were taken after the eruption, forcing heat toxins into the Lung. Consequently, irritability, confusion, loss of appetite, or difficulty in urination and defecation occur, all of which are ominous signs. Rash lesions containing white pus indicate light toxicity; whereas purple-black lesions hidden deep within the muscles indicate heavy toxicity. In severe cases, sores may form in the five Zang organs and the throat. If there is obstruction of urination and defecation, accompanied by painful and bloody urine, black eschars without pus formation, death is certain. Similarly, black qi emanating from the nostrils indicates death. If the rash has not yet erupted, but toxins have penetrated internally, causing staring eyes, upward gaze, convulsions, and screaming resembling wind-stroke (Jing Feng), this is actually a sign that the rash is about to erupt. Misdiagnosing this as epilepsy (Jing Xian) and treating accordingly will cause toxins to accumulate internally and evil heat to remain unvented, also leading to death. If the rash has erupted but delirium persists, this is also an ominous sign. If, upon seeing such lesions, one uses resolving and promoting herbs, causing the rash to retract, death ensues; urgent warming treatment is required to bring the rash back out for recovery. If the lesions turn white and suddenly retreat into the Zang-Fu organs, gradually becoming purple-black without pus, accompanied by day-and-night irritability and crying, the condition is extremely dire. Taking Huadu San (Toxin-Transforming Powder) allows the toxin to exit through the palms and soles, leading to recovery; this is a "five deaths, one life" critical prognosis. Hematochezia with depressed, pus-less lesions indicates death. For those with plague-toxin smallpox that fail to erupt, one method involves administering a decoction of Sheng Dihuang (Rehmanniae Radix Recens) and Xionghuang (Realgar). The dosage must not be excessive, as too much may cause harm. All the aforementioned conditions are ominous prognoses.