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Fever associated with smallpox and measles is generally similar to Shanghan (Cold Damage) in the early stages. However, the pathogenic factor of Shanghan enters from the exterior into the interior, thus presenting syndromes of the various meridians; whereas the toxin of smallpox and measles emerges from the interior to the exterior, thus presenting syndromes of the five Zang organs. For instance: yawning and drowsiness indicate a Liver syndrome; alternating chills and fever, slightly cold hands and feet, and excessive sleepiness indicate a Spleen syndrome; dry face, red cheeks, coughing, and sneezing indicate a Lung syndrome; fright and palpitations indicate a Heart syndrome; cold ears and coldness indicate a Kidney syndrome. Furthermore, observing redness at the epigastrium, red veins behind the ears, tears in the eyes, generalized body heat, heat in all fingers but coldness specifically in the middle finger, allows one to ascertain that this is a smallpox/measles condition. One must carefully distinguish between deficiency and excess patterns and treat according to the specific manifestations.

Coldness at the tips of all five fingers indicates severe fright convulsions that are difficult to withstand. If the middle finger is warm, it is certainly Shanghan; if only the middle finger is cold, it is transmitted as a sign of mumps/smallpox or measles. For females, observe the right hand; for males, the left hand. The distinction should be clear and requires careful observation.

Red veins on both ears suggest that the smallpox will be mild; where purple veins appear, the condition is heavy and profound. Urgent treatment with attacking medications is required; among ten cases, it is rare to save three or five.

The method for initially examining smallpox involves using a lit paper wick dipped in oil to illuminate the pustules/granules, followed by touching the cheeks with the hand. If the redness turns white upon pressure and returns to red upon release, this is called "active blood," indicating that vitality remains. If wiping does not make it white and lifting does not make it red, this is called "exhausted blood"; even with lenient treatment, the prognosis is critical. Additionally, observe the spirit and luster of the eyeballs, as well as the lips and tip of the tongue. If they are red and vibrant as usual, without dry or pale white discoloration, this is an auspicious omen, and there is no cause for worry. This constitutes the general approach to observing smallpox and measles.

Regarding the method of examining smallpox, once fever appears, the pulse must be inspected first. Generally, before the rash manifests visibly, fever must precede it; once fever is observed, the pulse will necessarily be slippery and rapid (Hua Shu). However, if the pulse is merely slightly slippery and rapid with sufficient spirit and retains a harmonious and relaxed quality, the smallpox will likely be mild and sparse. If the slipperiness and rapidity double but still retain a harmonious quality, the smallpox will be numerous and severe, yet still not immediately dangerous. If the slipperiness and rapidity are extreme, accompanied by wiry and restless qualities, or if the pulse is hollow and urgent (Kou Ji) without spirit and completely lacks a harmonious quality, the smallpox will be severe and critical. Therefore, I can determine the auspiciousness or inauspiciousness during the initial maturation stage of the rash. People are often amazed and convinced by my judgments but do not realize that the key lies in the pulse. The method for diagnosing this is simply to hold the child's hand firmly and use only the thumb to palpate, which is also the easiest approach. This is the primary method for examining rashes, yet many contemporary physicians are unaware of it, largely because ancient texts did not emphasize it.