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Whatever things attain balance remain quiet; losing balance leads to movement. The Classics state: "When Yang Qi is quiet, it nourishes the Shen (Spirit); when soft, it nourishes the Jin (Tendons)." It also states: "When Yin Qi is quiet, the Shen is stored within; when restless, it dissipates and perishes." In patients suffering from smallpox (Dou Chuang), both Yin and Yang are diseased. Respiration should be even, speech should be minimal, sleep should be stable, and waking consciousness should be peaceful. When hungry, they seek food; when thirsty, they drink sparingly. They groan when touching their sores and cry out when their desires (such as itching) are disturbed. These are signs of a balanced person with clear and calm Shen, termed "quiet," which indicates a favorable prognosis.

Groaning indicates physical pain. Muttersing in one's sleep indicates unclear Shen. Rapid and coarse breathing indicates internal Heat. Bowel sounds indicate diarrhea. Restlessness in sitting or lying down indicates mental restlessness (Xin Fan). Unceasing crying and shouting indicate pain. Shaking the head indicates Wind. Wanting to scratch with fingers indicates itching. Difficulty swallowing indicates sore throat. Clenching teeth indicates Heart and Liver Heat. If there is confusion, agitation, delirium, dizziness, hallucinations (seeing ghosts), shaking of the head and neck, flailing of limbs, upward deviation of the eyes, chills with teeth clenching, and inability to speak, these are all signs of impending death.

If the condition tends toward quietness but suddenly becomes agitated, this is abnormal. One must investigate using appropriate methods. If the color of the lesions changes without other symptoms, this is due to contact with aberrant pathogenic factors (Li Qi). If the lesion color remains unchanged and there are no other symptoms, there must be a specific cause; one should simply wait for it to stabilize on its own. If there is closed eyes, faint respiration, rigid limbs, locked jaw, necrotic lesions, deep coma, these are signs that True Qi is about to collapse and Hun and Po are about to depart. This cannot be diagnosed as "quiet" (favorable).

Some say that the signs of smallpox cannot be determined by pulse diagnosis alone but can be distinguished by Xing (Form) and Se (Color). "Xing" refers to the shape of the pustules. Thus, there is the initial form (sharp, round, firm, dense); the form of flourishing growth (robust); the form of fullness and sufficiency (formation of pus); and the form of contraction and consolidation (scabbing and falling off). Shapes resembling soybeans, mung beans, or peas are considered normal forms. Flatness or depression represent variations in form. For example, if initially appearing empty like shed silkworm skins, faint like mosquito bites, thin like bran flakes, or dense like needleheads—resembling heat-induced miliaria or cold-induced millet-like papules—they will fail to erupt and lead to death. Adhesion, blurriness, floating and loose flesh, soft and tender skin, or ulcerated skin will fail to scab and lead to death.

"Se" refers to the color of the lesions. Brightness is preferred over dimness; moisture is preferred over dryness; a mature, waxy luster is preferred over delicate tenderness. Red should not be fiery; if fiery, it breaks easily. White should not be grayish; if grayish, it fails to scab. The progression from red to white, white to yellow, and yellow to black represents the normal colors corresponding to eruption, development, pus formation, and scabbing. Purple hue at eruption and grayish-white at development are color abnormalities. By distinguishing the form and color of smallpox, one can predict the time of life or death.

Ancient experts observed four aspects of smallpox: Gen (Root), Ke (Nest), Jiao (Foot), and Di (Ground). These are unchanging methods to verify auspiciousness and determine life or death. What is Ke? It is where the center is transparent and the top rises. What is Gen? It is the outer ring that is red. By observing whether the ring is red, one can see the deficiency or excess within and the depth of the toxin. By observing whether the Ke rises, one can determine the depth of the Gen and the sufficiency or deficiency of Qi and Blood.

What are Jiao and Di? They depend on the roundness and mixing of the Gen and Ke, and the density of the pustules. The area of red halo is called Jiao. If particles are distinct, not scattered or mixed, the Jiao is clear. The empty space between particles is called Di. If particles do not connect, the Di is clear. The Gen should be active; the Ke should rise; the Jiao should be solid; the Di should be broad. If all four are harmonious, even dense eruptions need not be feared.

"Wan" (roundness) is the form of Qi. Abundant Qi ensures the Ke is complete, neat, and clean. "Yun" (halo) is the form of Blood. Abundant Blood ensures the Ke is bright, red, and lively. Qi deficiency causes the top to sink; Qi dispersion causes collapse and obstruction. Even if extremely Qi-deficient lesions do not collapse, it may be due to Fire carrying them up; although appearing round, they are actually empty shells like blisters. Blood deficiency makes the halo pale; Blood exhaustion makes the halo withered, causing the root to scatter. Even if extremely Blood-deficient lesions appear red, it may be due to Fire floating upward; although a halo appears, it is actually withered and lacks moisture. The brightness or dimness of the lesion color depends on the deficiency or excess of Qi and Blood. Red indicates initial eruption; white indicates unresolved toxin; yellow indicates resolving toxin; dry yellow indicates resolved toxin; grayish-white indicates Qi decline and Blood detachment; purple indicates abundant toxin and Blood stasis; black indicates extreme Heat combined with Water transformation; brown/blackened indicates Qi and Blood exhaustion. Red turning to white, white to yellow, is a smooth progression leading to life. Red turning to purple, purple to black, is a reverse progression leading to death.

During initial examination, dip red paper in pure oil, ignite it, and use the light to check for vitality. Rub the cheeks with the hand; if the redness turns white upon rubbing and returns to red immediately, it is called "active Blood," indicating vitality exists. If rubbing does not turn it white and lifting does not make it red, it is "exhausted Blood," which is untreatable even if sparse. Also observe that the eyes have clear spirit, the tip of the lips is red and lively as usual, without dry whiteness. This is an auspicious sign, requiring no worry.