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For all things, when they attain equilibrium, they are still; when they lose equilibrium, they move. The Classics state: "When Yang Qi (vital energy) is still, it nourishes the Shen (spirit); when it is soft, it nourishes the Jin (tendons)." It also states: "When Yin Qi (nutritive energy) is still, the Shen is stored within; when it is restless, it dissipates and perishes." In patients suffering from smallpox (variola), both Yin and Yang are diseased. Respiration should be even, speech should be minimal, sleep should be stable, and waking should be peaceful. When hungry, they seek food; when thirsty, they drink sparingly. If touched at the sores, they groan; if their desires are thwarted, they cry out. These are signs of a balanced person, with clear Shen and stable spirit, termed "stillness," which indicates a favorable prognosis. Moaning indicates bodily pain. Mutters to oneself indicate unclear Shen. Rapid and coarse breathing indicates internal heat. Borborygmus (bowel sounds) indicates diarrhea. Restlessness in sitting or lying down indicates mental agitation. Unceasing crying indicates pain. Shaking the head indicates wind pathogen. Desire to scratch fingers indicates pruritus. Difficulty swallowing indicates sore throat. Grinding teeth indicates Heat in the Heart and Liver. However, if there is confusion, restlessness, delirium, dizziness, hallucinations (seeing ghosts), shaking head and twisting neck, flailing hands and kicking feet, upward deviation of the eyes, rigors with teeth grinding, and inability to speak, these are all signs of impending death. If the condition tends toward stillness but suddenly becomes agitated, this is abnormal; one must investigate using appropriate methods. For instance, if the color of the lesions changes without other symptoms, this is caused by contact with aberrant Qi (pathogenic factors). If the lesion color remains unchanged and there are no other signs, there must be a specific cause; one should simply wait for it to stabilize on its own. If there is closed eyes, faint respiration, stiff and straight limbs, trismus (lockjaw), necrotic sores, and deep sleep without awakening, these are signs that True Qi is about to collapse and Hun and Po (ethereal and corporeal souls) are about to depart. This cannot be diagnosed as "stillness."

Some say that the signs of smallpox cannot be determined by pulse diagnosis alone, but can be distinguished by observing Xing (form) and Se (color). By "Xing," we mean the shape of the pustules. Thus, pointed, round, firm, and dense shapes represent the initial eruption. Lush growth represents the stage of vigorous development. Full and plump shapes represent the stage of pus formation. Contracted and solid shapes represent the stage of scabbing. Shapes resembling soybeans, peas, or mung beans are all normal forms. Flat or depressed shapes are variations of form. For example, initially empty like shed silkworm skins, faint like mosquito or flea bites, thin like bran flakes, or dense like needle heads, resembling miliaria (heat rash) or hordeolum (cold grain), these will fail to erupt and result in death. Clumped, blurred, with vacuous and floating flesh, soft and tender skin, and ulcerated epidermis will fail to scab and result in death. By "Se," we mean the color of the pustules. Brightness is preferred over dullness; moisture is preferred over dryness; a waxy hue is preferred over delicate tenderness. Red should not be fiery red, as it breaks easily; white should not be grayish, as it fails to scab. The progression from red to white, white to yellow, and yellow to black represents the normal colors of eruption, development, suppuration, and crusting. Purple tint during eruption and grayish-white during development are color abnormalities. By distinguishing the Xing and Se of smallpox, one can predict the timing of life or death.

Ancient experts examined smallpox based on four aspects: Gen (root), Ke (nest), Jiao (foot), and Di (ground). These are unchanging methods to verify auspiciousness or inauspiciousness and determine life or death. What is Ke? It refers to the center being transparent and rising to a peak. What is Gen? It refers to the outer ring being red. From whether the ring is red, one can see the deficiency or excess within, and the depth of the toxin. From whether the Ke rises, one can determine the depth of the Gen and the fullness or emptiness of Qi and Blood. "Jiao" and "Di" depend on the roundness and mixing of the Gen and Ke, and the density of the pustules. The area with red halo is called Jiao; if particles are distinct, not scattered or mixed, this is "clear Jiao." The empty space is called Di; if particles do not connect, this is "clear Di." The Gen should be active, the Ke should rise, the Jiao should be solid, and the Di should be broad. If all four are harmonious, even dense smallpox need not be feared. "Wan" (roundness) is the form of Qi; abundant Qi ensures the Ke is complete, circular, and clean. "Yun" (halo) is the form of Blood; abundant Blood ensures the Ke is bright, red, and vital. Qi deficiency leads to sunken peaks; Qi dispersion leads to collapse. Even if Qi is extremely deficient without sinking, it may be carried by Fire; although appearing round, it is actually an empty shell like a blister. Blood deficiency leads to pale halos; Blood exhaustion leads to withered halos, causing the root to scatter. Even if Blood is extremely deficient yet appears red, it is due to Fire floating upward; although a halo is seen, it is actually withered and lacks moisture. The brightness or dimness of smallpox color depends on the deficiency or excess of Qi and Blood. Red indicates initial eruption. White indicates unresolved toxin. Yellow indicates resolving toxin. Dry yellow indicates resolved toxin. Grayish-white indicates Qi decline and Blood detachment. Purple indicates excessive toxin and Blood stasis. Black indicates extreme Heat combined with Water transformation. Scorched brown indicates exhaustion of Qi and Blood. Red turning to white, white turning to yellow, indicates a smooth course leading to survival. Red turning to purple, purple turning to black, indicates a reverse course leading to death.

During initial examination, dip red paper in clarified oil, ignite it, and use the flame to illuminate the lesions to check for vitality. Rub the cheeks with hand; if the redness turns white upon rubbing and returns to red immediately, this is "active Blood," indicating vitality exists. If rubbing does not turn it white, and lifting does not make it red, this is "exhausted Blood"; even if sparse, it is untreatable. Also observe that the eyes have clear and bright Shen (spirit), and the tips of the lips are red, vital, and normal, without dry whiteness. This constitutes a favorable sign, requiring no worry.