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There are three types of smallpox/rubella progression: favorable (Shun), precarious (Xian), and unfavorable (Ni). It is essential to understand these when treating the disease. Favorable signs indicate auspiciousness. Unfavorous signs indicate peril. Precarious signs indicate a state between fortune and misfortune, evoking regret or caution. If the condition is auspicious (favorable), no specific treatment is needed; forcing treatment may lead to adverse outcomes. If the condition is inauspicious (unfavorable), treatment is futile and unnecessary. However, precarious conditions require intervention.

Irregular eruption of lesions results from uneven distribution of Qi and Blood. When Qi and Blood are abundant, toxins are easily resolved, manifesting as a favorable course, which heals spontaneously without treatment. If Qi and Blood are deficient, toxins are difficult to resolve, manifesting as an unfavorable course, where treatment yields little benefit. Only when Qi and Blood are slightly weak, preventing immediate toxin resolution and lacking stability in the middle Jiao, must supportive and tonifying measures be applied. As stated, "Those who receive assistance prosper; those who lose assistance perish."

When lesions are sparse and toxin load is low, pathogenic factors cannot overcome healthy Qi. The body's Qi harmonizes naturally, and the disease course proceeds smoothly without medication. Conversely, when lesions are dense and toxin load is high, pathogens and healthy Qi contend. The body's Qi becomes pathological, and the course becomes precarious. In such cases, one should suppress pathogens and support healthy Qi, rapidly depriving pathogens of their power so they do not harm healthy Qi. If lesions are densely packed without gaps and toxins are severe, healthy Qi fails to overcome pathogens. The body's Qi becomes disordered, and the course turns unfavorable. Even skilled physicians may find themselves helpless. Thus, favorable courses require no treatment, precarious courses benefit greatly from timely treatment, and unfavorable courses are generally untreatable. This principle is evident here.

Ying (Nutritive) Qi circulates within the vessels, while Wei (Defensive) Qi circulates outside the vessels. They protect each other internally and externally, nourishing one another, aligning with the generative way of Heaven and Earth without fault. Ying and Wei are rooted in Yuan (Original) Qi. When Yuan Qi is solid, Ying and Wei maintain yin-yang harmony inside and outside the vessels without interruption, allowing blood to remain contained and functional. If Qi remains internal without reaching the exterior, blood carries toxins outward causing external ulceration. If Qi remains external without connecting inward, blood carries toxins inward causing internal attack. This illustrates the principle that "when Yang is deficient, Yin follows; when Yin is deficient, Yang follows." Therefore, Ying and Wei represent the virtue/function of Qi and Blood. Qi and Blood serve as the dwelling for smallpox toxins. Smallpox toxins act as thieves against Qi and Blood. When Ying and Wei are strong, they battle the "thieves," preserving the "dwelling." When Ying and Wei weaken, the "thieves" wreak havoc, damaging the "dwelling." If blood cannot carry, lesions collapse; if Qi cannot constrain, lesions sink. Hence, smallpox requires regulating and tonifying Qi and Blood. Generating blood stabilizes the interior; strengthening Qi enhances the exterior. Ying Blood follows the direction of Qi, rooting internally; Wei Qi follows the direction of Blood, protecting externally.

The human body relies fundamentally on Ying and Wei. Wei Qi, a form of Yang Qi, regulates opening and closing (pore function) and moves the physiological pivot. Ying Qi, a form of Yin Blood, fills the Zang-Fu organs and irrigates the limbs. Thus, Qi deficiency halts vital mechanisms; Blood deficiency cuts off the source of transformation. Neither should dominate excessively.

Smallpox toxins originate from the fluids of the Five Zang organs, traveling along meridians to directly invade Ying and Wei before erupting. Qi and Blood respond accordingly. Observing firm, thick interiors and full, long pustule sacs indicates sufficient Qi. Red, vibrant roots and moist, lustrous colors indicate sufficient Blood. With adequate Qi and Blood, eruptions appear and crust over easily, requiring no treatment to avoid the error of "treating excess with excess" (adding to an already full condition). Flat, sunken, tender, and thin lesions indicate Qi pathology. Dry, purple-black lesions indicate Blood pathology. These require prompt treatment to avoid regretful delays.

Spleen and Stomach are the "parents" of Qi and Blood. Heart and Kidney are the "mothers." Liver and Lung are the "residences." Spleen processes food and water; its vigorous Qi enters the Kidney to transform into Qi. This Qi resides in the Lung to become Wei Qi, warming muscles, filling skin/hair, thickening interstices, and controlling opening/closing. If Wei Qi is deficient, lesions fail to rise; toxins enter the Lung due to Qi deficiency, causing sinking/obscuration, eventually affecting the Kidney. Spleen processes food/water; its essence enters the Heart to transform into Blood. This Blood resides in the Liver to become Ying Qi, flowing through the nine orifices, saturating the six Fu organs, and meeting all vessels. If Ying Blood is deficient, lesions lack luster; toxins enter the Liver due to Blood deficiency, causing itching/collapse, eventually affecting the Heart.

Therefore, treat Qi diseases by addressing Qi, and Blood diseases by addressing Blood. Cold is treated with warmth; Heat with clearing. Deficiency with tonification; Excess with purging. The Spleen and Stomach remain central and must not be violated. Cold-cooling detoxifying herbs that damage Stomach Qi or drain Heart Fire should not be used lightly.

Blood’s nourishment is like flowing water, circulating and irrigating, subtly fostering creation without rest. Qi’s defense is like a fortified border, solid and vast, nurtured straightly without harm. Smallpox depends entirely on Ying and Wei from start to finish. Without Qi and Blood, toxic attacks cannot be manifested; without them, physical features cannot stand tall; without them, pustule structures cannot fill. Thus, Qi and Blood must not separate, nor should Yin and Yang conflict or dominate exclusively. Blood (Yin) tends downward; Qi (Yang) tends upward—this is natural law. If Yin invades Yang, Qi loses balance, risking dark-purple nodular lesions. If Yang overwhelms Yin, Blood is driven by pathogens, risking gray/black collapsed lesions. Excess Yang implies Heat, which damages Qi, leading to sinking/obscuration due to Qi deficiency. Excess Yin implies Cold, causing Qi/Blood stagnation and inhibiting growth.

Thus, harmonious Qi and Blood are crucial during eruption. During fever, as color emerges, heat should be mild, Qi calm, urination/stool normal, lower/upper aspects not overly red, and pulses not overly surging. Numerous spots with broad bases and sharp tips, vividly red, indicate harmonious Qi and Blood. From day 1 to 2-3, absence of foul breath, bright luster, firm palpable bumps, daily growth, no spreading macules, even with cough/sneeze/yawning/startle, indicates harmonious Qi and Blood. From day 4 to 6, resembling dew-kissed peach blossoms, pleasing appearance, mild swelling, normal diet, indicates abundant/moistened Qi and Blood. From day 7 to 9-10, lustrous as pearls, full pus, vigorous spirit, red base/top, fever without irritability, thirst without diarrhea, indicates tranquil Qi and Blood. From day 10 to 12, crusting at bases, waxy luster, regulated stool/urine, indicates solidified Qi and Blood. From day 13 to 16, clear eyes, fallen scabs, fading fever, indicates restored Qi and Blood.

If, during the rising phase, lesions are flat/thin/dry/purple-black, with vomiting/diarrhea, convulsions, or blisters; if, during the filling phase, pus is clear, tops sunken, bases diffuse, appetite poor, fever causes coma, pus is gray/white or dry/swollen; if, during the crusting phase, no scabs form, frequent diarrhea, hoarse voice, rapid shallow breathing, cough, and anorexia occur—all indicate Qi/Blood pathology, incomplete Ying/Wei circulation, disordered Yin/Yang, internal toxin attack, and organ failure. Qi and Blood are critical to smallpox; how can they be ignored? Assuming all sores belong to Heart Fire and using cold-draining Heart methods causes blood coagulation and toxin stasis. As the Monarch, how can the Heart circulate blood to achieve success under such conditions?