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If the smallpox has not yet erupted but the voice is hoarse and there is rattling in the throat, it is incurable. If this occurs within five days after eruption, it is also incurable.

If the smallpox has not yet become vigorous but is scratched open first, showing no Qi and Blood sufficiency, it is incurable.

If phlegm and saliva are abundant and obstructing, accompanied by rapid breathing, it is incurable.

If the smallpox has not erupted or has already erupted, but the spirit is confused, breath is short, and there is restlessness and agitation, it is incurable.

If there is abdominal pain accompanied by purulent bloody diarrhea, it is incurable.

If the muscles are dark black as if beaten with a staff, it is incurable.

If one cannot take even a mouthful of porridge or rice water, or if food and drink choke the throat, it is incurable.

If the spirit in the eyes is dim, and the color of the eyeballs turns green or red, it is incurable.

If the patient sleeps with closed eyes in a coma, with the tongue curled up and the scrotum retracted, it is incurable.

If the head is warm while the feet are cold, accompanied by stifled confusion and thirst for drinking, it is incurable.

If vomiting and diarrhea persist without cease, and medicines and food pass through without digestion, exiting the anus directly like a bamboo tube, it is incurable.

If stomach heat causes jaundice, the body is orange-yellow, accompanied by diarrhea, it is incurable.

If the smallpox appears initially as cyan, dull, scorched, and black, it is incurable.

If the lesions are dense like silkworm eggs, completely failing to erupt, flat and patchy, it is incurable.

If the sores itch and chills persist without ceasing, it is incurable.

If there was a pre-existing ulcer leaking Qi and Blood, and topical applications were ineffective, it is incurable. Thus it is said: "Do not fear smallpox on the Five Centers (palms, soles, and chest); fear the leakage of the original ulcer." The original ulcer refers to sores present before the eruption of smallpox; leaking pus and blood from them is extremely ominous. However, if the smallpox on the Five Centers is sparse and dietary intake is normal, it is not a matter of concern.

If wind-cold or food stagnation injures the patient after smallpox recovery, leading to emaciation and muscle wasting, it is incurable.

Apart from the above, although there may be miscellaneous dangerous syndromes and dense eruptions, as long as there is a sign of moistening and rising, relying on the physician's superior skill, the family's unwavering trust, and careful nursing, full recovery can be achieved.

Strange smallpox represents the most severe form of adverse smallpox. Its forms and syndromes vary and must be distinguished.

First, when smallpox initially erupts, red spots appear on the face, chest, hands, and feet, but they fail to erupt, do not form pus, and immediately retract. If accompanied by rapid breathing, hoarseness, and mental confusion, death ensues immediately. This is called the Internal Collapse Syndrome. If this syndrome lacks signs of irritability, panting, and confusion, it is called Trial Smallpox. After five to seven days, fever will return and the rash will re-emerge; such cases are severe.

Second, smallpox initially appears resembling mosquito or flea bites, but disappears after three days. This is called Reverse Guan Smallpox, resulting in death within five days.

Third, smallpox papules appear in clusters of two or three, with hard, nodular bases. This is called Smallpox Mother, resulting in death within six to seven days.

Fourth, before eruption, there are red, swollen, hard nodules on the body that resemble tumors but are not, or abscesses but are not. This is also called Smallpox Mother, resulting in death within three to five days. Both of the above conditions should be treated with Zhenren Jiedu Tang (Genuine Human Detoxification Decoction).

Fifth, smallpox initially forms blood blisters or water blisters that rupture immediately. This is called Rotten Smallpox, resulting in death within two to three days.

Sixth, after eruption, the entire body consists of empty shells without pus formation. This is called Empty Smallpox, resulting in death within eight to nine days.

Seventh, during the eruption and rising phase, some lesions turn dry and black. This is called Ghost Smallpox. It should be applied with Carminative Water to prevent spreading. If not treated urgently, the lesions will rise and fall intermittently, fail to crust when expected, or erupt repeatedly over a prolonged period, leading to death.

Eighth, during the eruption and rising phase, some lesions are extremely painful as if carved by a knife, causing continuous crying and screaming. This is called Smallpox Carbuncle, resulting in death within five to six days.

Ninth, during the rising phase, the lesions are dry and unmoistened, lie flat without rising, and the skin wrinkles and peels. This is called Dry Smallpox, leading to death within five to six days due to increasing irritability, fullness, and wheezing.

Tenth, during the rising phase, the skin is tender and easily broken, feeling warm to the touch. This is called Warm Smallpox, resulting in death within six to seven days due to itching.

Eleventh, during the rising phase, the sores have a delicate, charming color, thin and smooth skin, and are bright red and attractive. This is called Tender Smallpox. By the eighth or ninth day, scabs fail to form, and death ensues due to itching.

Twelfth, during the rising and pitting phase, holes appear on the pustule heads, and fluid leaks out. This is called Leaking Sore, resulting in death within five to six days due to itching.

Thirteenth, Thief Smallpox refers to lesions that mature prematurely before other lesions have formed pus. Also known as False Cloud Flooding. It often occurs at the Taiyang acupoint, throat, mouth, heart, and chest areas. If seen on the third day, death occurs on the sixth; if seen on the fourth, death on the seventh; if seen on the fifth or sixth, death on the eleventh or twelfth day.

Fourteenth, although the eruption is sparse, the bases are entirely white without blood color. After three to four days, they may swell, but feel hollow upon pressure. This is also called Thief Smallpox, indicating extreme deficiency of Qi and Blood. During the pitting stage, they will inevitably turn into blisters the size of grapes, with paper-thin skin; scratching them leads to death.

Fifteenth, when pus is about to form, the sore ruptures spontaneously with a deep hole. This is called Inverted Collapse.

Sixteenth, during the crusting phase, scabs fail to form, the skin falls off, and the bone turns black. This is also called Inverted Collapse, and is incurable.

Seventeenth, during the crusting phase, scabs fail to form, the skin and flesh ulcerate, and pus flows profusely. This is called Smallpox Leprosy. Survival is possible if the patient can eat; death ensues if they cannot. All the above conditions are considered incurable.