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1. During the initial appearance of smallpox lesions, if they are sparse on the head and face, absent from the chest and back, with a ruddy base, prominent tops that are palpable, and lustrous like pearls, this is an auspicious sign of the highest order; medication is not required.

2. After fever persists for three to five days and subsides slightly, a few lesions may appear first around the mouth, nose, cheeks, chin, neck, or limbs. These lesions vary in size, have a pale red luster, and show a clear distinction between the lesion color and the surrounding skin (red vs. white). This is an auspicious sign.

3. If lesions erupt in two or three waves, completing their emergence on the palms and soles only after three days, and subsequently remain sparse on the head, face, chest, and back, with sharp, round, firm shapes, while diet and excretion remain normal, this is an auspicious sign. In the absence of other symptoms, arbitrary use of medication should be avoided.

4. When smallpox lesions first emerge, those appearing in clusters of three to five will necessarily be dense, whereas those appearing singly will necessarily be sparse.

5. Smallpox lesions being more abundant on the upper body and fewer on the lower body is auspicious; the reverse indicates danger.

6. By the fifth or sixth day of fever, if lesions should have emerged but have not, inspection by lamp reveals only red spots within the skin. If the complexion and pulse are harmonious and no adverse signs are present, sudden dizziness accompanied by profuse sweating indicates that the toxic heat and lesions are expelling together through sweat. This is termed "Mao Dou" (Emerging via Sweat), indicating no risk of stagnation or obstruction, which is an auspicious omen.

7. The transformation of smallpox is unpredictable. Some patients exhibit no high fever yet show early lesions ("Bao Dou"), but these fail to suppurate or scab over, or appear and then disappear. This is termed "Shi Dou" (Test Lesions) and must not be mistaken for a mild condition. After a few more days, a sudden high fever will likely occur, followed by reappearance of lesions; careful treatment is required.

8. Lesions appearing on the first day of fever indicate a ominous prognosis. If they all erupt simultaneously, densely distributed like silkworm eggs, death is certain.

9. If several red spots appear before the major fever subsides, initially manifesting at the Taiyang acupoint, temple corners, hairline, Tianting point, or above the Shangen point, this indicates Yang toxin invading Yang regions due to deficiency, which is highly inauspicious. If accompanied by red eyes, cracked lips, phlegm rattling, purple complexion, or even whiter complexions, or if three to five lesions cluster together, this is termed "Tong Qian Dou" (Copper Coin Lesions). All are inauspicious signs requiring urgent blood-cooling and detoxification to prevent crisis.

10. Lesions appearing initially as purple-red patches are named "Zi Yun Dou" (Purple Cloud Lesions); death occurs four days later.

11. Lesions appearing initially with redness on the apex die within six to seven days. Ideally, lesions should be pale red like threads and attached below the root, not red on the apex.

12. If lesions erupt twice, accompanied by unceasing abdominal pain, foul breath, and a purple-black complexion, death is certain.

13. Lesions with thin skin, white and lustrous color, lacking any redness at the base, or showing only a trace of red, resembling mung beans after three to five days, will never suppurate. They form only a blister of clear fluid; rupture leads to death.

14. Lesions that are bright red and cause the skin and flesh to turn entirely red will never suppurate; death results from itching.

15. At the onset of lesions, if they completely fail to elevate, resembling water blisters or burns from moxa sticks, death by itching will occur after more than ten days.

16. At the onset of lesions, the presence of black spots resembling moles, or patches of black muscle tissue, indicates immediate death.

17. At the onset of lesions, if the mouth, nose, or ears turn purple-red, or if bleeding does not stop, death is certain.

18. At the onset of lesions, if they fail to emerge as expected, or if red macules resembling mosquito bites appear, death will occur after six days.

19. At the onset of lesions, if accompanied by waist and abdominal pain, delirious speech, restlessness, extreme thirst, vomiting and diarrhea, or inability to eat, the condition is incurable.

20. After lesions have fully erupted, if fever persists or worsens, death ensues.

21. After lesions have fully erupted, toxins having reached the exterior, the interior should be calm. If instead there is restlessness, confusion, and incessant delirium, this indicates extreme pathogenic qi and loss of Shen (Spirit) control; death is certain.