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The smallpox rash originally erupts due to heat pathogen. When the heat intensity is severe, eruption becomes more difficult. Therefore, before the spots appear, one should only use mild medications such as Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction), Shen Su Yin (Ginseng and Perilla Leaf Drink) (both for initial fever stage), Dongyuan Niuzangzi Tang (Echinopsiae Fructus Decoction by Li Dongyuan) (for overly dense eruption), Xingxing San (Xingxing Powder) (for initial fever) to resolve the exterior and promote eruption. If one disregards deficiency or excess and uses pungent-warm agents to induce heavy sweating, applying this to deficient patients might still offer a slim chance; however, if applied to individuals with excess conditions, it leads to rampant heat-toxin and closure of Ying (Nutrient) and Wei (Defensive) Qi. If internal toxin is severe, presenting as constipation and hematuria, this is termed "stagnant toxin not dispersing," where toxic qi has no outlet and counter-attacks the Zang-Fu organs. If external toxin is excessive, causing lesions to be depressed and unable to rise, resulting in inversion collapse, ulceration, or carbuncles, death is common at this stage if exterior resolution fails. This occurs because Yang is hyperactive and heat is blazing, lacking Yin Qi to harmonize. At this juncture, use Xiaodu Yin (Detoxification Drink) (for throat issues) or Qiwu Shengma Wan (Seven-Ingredient Cimicifuga Pill) (for initial fever) to disperse toxin, circulate Ying and Wei Qi, allowing the lesions to naturally rise.

When a child has fever for three days, then fever subsides and body cools, cooling then heats up again, heating then cools down, before the rash appears, emerging two or three at a time from the corners of the mouth and cheekbones, forming pairs, and fully erupting by the third, fourth, or fifth day, this is an omen of favorable progression. If red spots appear after only one or two days of fever, accompanied by vomiting, diarrhea, abdominal pain, tremors with warm body, anorexia, and lethargy, and by the third or fourth day the lesions fail to rise, lack luster, appear dull and dark, with white areolas, these are signs of deficiency-cold, termed "dangerous" but treatable and curable. However, if fever is too intense, with restlessness, chest oppression, confusion, rapid breathing, anorexia, and alternating fever patterns where lesions suddenly erupt all at once in red-purple-black colors without rising or spreading smoothly, lacking luster, this indicates interior-exterior excess-heat. If lesions emerge extensively from the Taiyang region or Tianning area, it is an ominous sign, difficult to treat.

When lesions emerge sparsely on the head and face, absent on the chest and back, with reddish-pink areolas, pointed tops that feel rough to touch, and glistening like water droplets, this is the highest auspicious sign, requiring no medication.

If, upon emergence, there is restlessness, unceasing lower back and abdominal pain, foul breath, and purple spots, death ensues. Emergence of blue-green spots resembling indigo dye also indicates fatal prognosis.

If lesions are white, thin-skinned, and glossy, with areolas completely lacking redness or showing only a slight red tint, growing to mung bean size within three to five days, these lesions will definitely not fill with pus. Later, they become sacs filled with clear fluid; rupture leads to death. Do not administer drugs merely because they look aesthetically pleasing.

If lesions completely fail to form a peak, or if peaks resemble blisters or charred rush stems, death occurs ten days later due to itching and collapse.

Red streaks appearing like brocade patterns upon emergence indicate death within six days; skin resembling snake scales indicates death.

Black spots appearing like moles, with muscle tissue turning black in clumps, indicate death on the same day.

If the body fever does not penetrate thoroughly, yet spots appear and disappear repeatedly ("playing with the tip"), it is called "Nongbiao Rash." Smallpox relies on thorough heat penetration for smooth skin circulation and easy eruption. Lack of heat penetration means the "ground is unripe," causing lesions to emerge and vanish, hide and re-emerge. This signifies extreme deficiency of Qi and Blood, lacking strength to vent, making it difficult to treat.

Lesions that are red-purple, scorched, dry, adherent to the skin without rising, thick and black like iron, unbreakable upon pricking, and devoid of pus or blood, are called "Iron Armor Rash." This results from stagnant Qi failing to nourish and枯竭 Blood failing to moisten, with toxin pressing into skin and flesh, leading to death within eight to nine days.

Once lesions have erupted, those sparse and distinct on the head and face, few on the neck, and sparse on the chest indicate light toxicity. Conversely, if the face is blurred, swollen before eruption, neck densely covered, and chest crowded, toxicity is severe and untreatable.

When lesions have fully erupted and are about to rise, if blood blisters appear, toxin is hidden in the Heart, leading to immediate death. If water blisters appear, toxin is hidden in the Liver, leading to death shortly after itching and collapse.