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At the time when smallpox spots appear, one must first observe their location to determine the auspiciousness or inauspiciousness and severity of the condition. Smallpox is a Yang pathogen; therefore, it manifests on the face first following the ascent of Yang Qi. Spots appearing on both sides of the mouth and nose, above and below the Renzhong (philtrum), between the cheeks, ears, and the Niushou (tip of the nose) are auspicious. If they appear on the Tianting (forehead center), Sikong, Yintang (between eyebrows), Fangguang, or Taiyang (temples) areas, these are not favorable omens. Generally, spots appearing between the eyebrows and the chin, within the central Yangming meridian region, are auspicious. However, spots appearing at the brow center extending up to the hairline and the Taiyang region are mostly inauspicious. Spots appearing on the cheekbones and beside the ears in the Shaoyang region are also dangerous. Zhu Jichuan stated: "When I first practiced medicine, I relied on the previous theories but often found them inaccurate. After studying intently for over thirty years, I found that spots appearing first on the central forehead and both zygomatic arches are mostly smooth cases. Those appearing first at the Renzhong and around the mouth and nose are mostly perilous. Pre-existing edema of the lips or eyelids indicates severe poisoning of the Spleen and Stomach, which is particularly dangerous. Appearance in the Taiyang, chin, cheeks, and ear regions is mostly adverse. Cases where spots do not appear on the upper body first but rather on the lower body indicate weak Yuan Qi (Original Qi). The processes of pustule formation and scabbing follow similar patterns."

If the initial spots appear in the auspicious areas of the face, spaced about one to two cun apart, with sharp, fine shapes and a pale peach-red color, the eruption will be sparse and the condition mild. If the initial spots appear in the inauspicious areas of the face, clustering two or three together, or forming groups of five or six, with colors ranging from crimson to pale white, flat tops, and lackluster spirit, the eruption will be dense and the condition severe. Zhang Jiegeng said: "Eruptions that are dense like needle heads immediately upon appearance indicate a serious condition. For mild cases, treat internally with exterior-cooling methods using Lianqiao Shengma Tang (Forsythia and Cimicifuga Decoction)." However, each dense area corresponds to specific meridian regions: the forehead governs the Heart, the face governs the Stomach, the abdomen and limbs govern the Spleen, the hypochondrium governs the Liver, the axillae govern the Lungs, the waist and feet govern the Kidneys, and the shoulders and back govern the Bladder. Treatment should be based on the specific manifestations. If the complexion is yellow, stool is black, accompanied by irritability, panting, thirst, or abdominal distension, this indicates blood stasis inside. Use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) or apply fresh rhinoceros horn juice. However, if the base of the pustules is distinct and full, there is no cause for concern.

The most critical aspect is that facial eruptions should be sparse, even, clear, protruding, red, and lustrous. Even if limb eruptions are dense, the patient can survive with proper treatment. Conversely, if facial eruptions are dense and flat, even if limb eruptions are sparse, one cannot lightly deem the prognosis good. Therefore, excessive eruptions on the forehead are called "Meng Tou" (Head Covered), on the neck "Suo Xiang" (Neck Locked), on the chest "Man Xiong" (Chest Concealed), and on the cheeks and jaw leading to confluent patches or vermilion-like redness indicates Liver excess suppressing the Spleen. By the eighth or ninth day, if diarrhea occurs and the patient refuses food, it becomes a critical condition. Eruptions on the limbs, though numerous, are less concerning. Although dense eruptions are generally critical, if facial pustules rise and fill easily, eyes open, and the patient can eat, it is treatable. If body eruptions are good but facial pustules are clear, flat, and unfilled, it is difficult to treat. If eruptions everywhere fail to rise, except for those on the face and buttocks which fill and open, it is treatable. If facial eruptions are good but absent on the nose, or present but fail to rise/fill, it is untreatable. Limb eruptions without body or facial eruptions are difficult to treat. Full-body eruptions with sufficient pus but none on the face result in death. Red and vibrant eruptions throughout the body but scorched and dry on the face result in death. Good eruptions everywhere but completely absent below the knees are ominous. In winter cold preventing eruption, wash repeatedly with warm Huixu Wine (Coriander Wine) and administer internal warming, resolving, and muscle-releasing herbs, adding Mugua (Chaenomeles) and Yiyiren (Coix Seed) to guide them. If delayed until the fifth day, treatment is futile.

If facial pustules are full and scabbed while limb eruptions have not yet filled, but the patient is lucid and eating, it is treatable. Asymmetry, such as presence on the left side of the face but absence on the right, or vice versa, indicates disconnection of Qi and Blood, making filling and opening difficult; these are mostly untreatable. Dense, gray-white eruptions on the lower half of the face with uniform, bright, red eruptions on the upper half should be treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If the upper half is dense, gray, and stagnant while the lower half is uniform, bright, and open, it is named "Yun Yan Tian Ting" (Cloud Covering the Heavenly Court) and is untreatable. Dense, red eruptions on the left half of the body with scattered points on the right indicate toxin manifesting in Yang (favorable); use Buzhong Yiqi Tang. Dense, gray, flat eruptions on the right half with scattered points on the left indicate toxin manifesting in Yin (adverse); although pus forms, it cannot consolidate, leading to death on the ninth day. Uniform, red eruptions all over the body but dense, gray, painful eruptions around the waist are named "Chan Yao" (Wrapping the Waist); toxin stagnates in Yin, fails to form pus, leading to death on the ninth day, or no later than the eleventh day. Dense eruptions all over the body but absent on the head and face indicate Yin toxin failing to ascend to Yang positions; this is untreatable.

For all the above conditions, except those deemed untreatable, one must unblock Ying and Wei (Nutritive and Defensive Qi), strengthen the Spleen, and generate fluids to prevent dryness, scorching, and blackening. Herbs for detoxification like Zicao (Arnebiae Radix et Rhizoma) are indispensable. For severe heat, use Huangqin (Scutellariae Radix), Lianqiao (Forsythiae Fructus), and Digupi (Lycii Cortex); for thirst, use Huafen (Trichosanthis Radix) and Wei Gegen (Prepared Puerariae Radix); for Qi deficiency, use Renshen (Ginseng Radix), [text missing, likely Huangqi or Baizhu], and Muxiang (Aucklandiae Radix); for constipation, use Zhike (Aurantii Fructus); for dysuria, use Mutong (Akebiae Caulis); for poor appetite, use Shanzha (Crataegi Fructus), Zhishi (Aurantii Fructus Immaturus), and Baizhu (Atractylodis Macrocephalae Rhizoma); for itching, use Baizhi (Angelicae Dahuricae Radix) and Chantui (Cicadae Periostracum); for distension, use Muxiang and Houpo (Magnoliae Officinalis Cortex); for abdominal pain, use Shaoyao (Paeoniae Radix) and Dingxiang (Caryophylli Flos). One must also assess the patient's constitution (large/strong vs. small/weak). Strong constitutions may still be treatable; weak constitutions are mostly incurable. As the proverb says: "A tree with few flowers bears little fruit; a small boat overloaded capsizes." This serves as an apt analogy.