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Xi Taishun stated: All wind diseases characterized by tremors and dizziness belong to the category of Liver Wood (liver dysfunction). However, when smallpox erupts, pathogenic toxins invade the Liver, seeking exit through orifices; thus, it initially presents with convulsions, cold extremities, and upward deviation of the eyes, resembling wind syndromes. Physicians must differentiate these convulsions caused by smallpox rash and must not hastily administer cooling agents for the Heart. If one fails to examine carefully and indiscriminately treats with anti-convulsant medicines, the Heart Qi will become cold and muscles will contract, causing toxins to sink inward, making it impossible for the pox to erupt. Nevertheless, convulsions occurring before the eruption of smallpox are mostly auspicious, while those after eruption are mostly inauspicious. Pre-eruption convulsions indicate that toxins are being vented outward, and heat naturally resolves; post-eruption convulsions indicate that Qi and Blood are deficient, causing toxins to stagnate. The concern is that the pustules may fail to fill adequately later, hence it is inauspicious. Physicians must exercise caution in differentiation.

Xi Taishun stated: All pain belongs to Excess patterns, and all itching belongs to Deficiency patterns. Pain is a favorable sign, while itching is an adverse sign. The Classics state: Excess refers to the abundance of pathogenic factors; Deficiency refers to the weakness of healthy Qi. Furthermore, sores and ulcers are associated with Fire. When Fire is vigorous, there is pain; when Fire is mild, there is itching. For instance, if smallpox lesions are firm, elevated, and itchy, this indicates Fire overflowing between the skin layers, wandering back and forth, thus causing itching. The treatment method should be cooling and detoxifying, fumigating externally with herbs such as Yinchen (Artemisiae Scopariae Herba) and Yuansu (Coriandri Fructus), which will stop the itching. If, around the seventh or eighth day, the skin is thin and the fluid clear yet itching occurs, this signifies that Blood cannot attach to transform into fluid via Qi transformation. Such itching is extremely difficult to endure, leading to scratching until the head and face are broken. If fresh blood flows profusely, immediately apply Baicao San (Defective Grass Powder) and cow dung ash externally, and internally administer cooling and attacking-toxin formulas, waiting for the lesions to turn foul and expel toxins. Although this is an adverse condition, it remains treatable; however, if scratched open without pus or blood, the lesions will inevitably dry up, accompanied by hoarseness and choking. Various complications will intensify, and by the tenth day, death is inevitable.

Xi Taishun stated: By the eighth or ninth day of smallpox, when the fluid has reached half-fullness and the red halo at the base has not yet receded, if the lesions suddenly turn entirely purple-black, ancients termed this "Dao Ye" (reversed indentation/collapse). Do not mistake this for scabbing. If the method of promoting eruption is appropriate, this condition can still recover. If petechiae appear on the sides and the condition becomes critical again, further treatment is warranted. However, if one observes rapid breathing, abdominal distension, irritability, panting, and thirst, this indicates toxins attacking inward and returning to the Zang-Fu organs. This is universally an adverse prognosis and is definitely difficult to treat.