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The eruption of smallpox is originally caused by the outward discharge of heat. The more intense the heat, the harder it is for the eruptions to emerge. Therefore, before the spots appear, one should only use mild and harmonious formulas such as Shengma Gegen Tang (Cinnamon Twig and Cimicifuga Decoction), Shen Su Yin (Ginseng and Perilla Drink) (both applicable in the initial fever stage), Dongyuan Niuzangzi Tang (Arctii Decoction by Li Dongyuan) (applicable when eruptions are too dense), and Xingxing San (Xingxing Powder) (applicable in the initial fever stage) to resolve the exterior and promote the discharge of toxins. If one ignores the deficiency or excess condition and rashly uses acrid-hot agents to induce heavy sweating, applying this to deficient patients might yield a slim chance of success; however, if applied to individuals with excess conditions, it will cause heat toxins to spread diffusely, blocking the Ying (Nutrient) and Wei (Defensive) Qi. If internal toxins are severe, leading to constipation and bloody urine, this is termed "stagnant toxin not dispersing," where toxic vapors have no outlet and attack the Zang-Fu organs instead. If external toxins are excessive, causing pustules to sink and fail to rise, resulting in inverted collapse, ulceration, or carbuncles, death occurs frequently at this stage due to the failure to resolve the exterior. This happens because Yang is hyperactive and heat is blazing, lacking Yin Qi to harmonize. At this juncture, use Xiaodu Yin (Detoxification Drink) (for sore throat) or Qiwu Shengma Wan (Seven-Ingredient Cimicifiga Pill) (for initial fever) to disperse the toxic vapors, circulate Ying and Wei Qi, allowing the pustules to rise naturally.

If a child has a fever for three days, then the fever subsides and the body cools, cools then fevers again, fevers then cools again, before the smallpox spots emerge, appearing two or three at a time from the corners of the mouth and cheekbones, becoming fully erupted by the third, fourth, or fifth day, this is an omen of a favorable course. However, if red spots appear after only one or two days of fever, accompanied by vomiting, diarrhea, abdominal pain, shivering, abnormal body temperature, anorexia, and lethargy, and if by the third or fourth day the pustules fail to rise, lack luster, appear dull and dark, and have white roots, these are signs of deficiency-cold, known as "dangerous" patterns, which are treatable and curable. If the fever is excessively high, with restlessness, chest oppression, confusion, rapid breathing, anorexia, and if the fever returns while the pustules erupt simultaneously in clusters, appearing red, purple, or black without rising or spreading smoothly, lacking luster, this indicates excess heat in both interior and exterior. If the eruptions spread widely from the Taiyang region or Tianning area, this is an ominous sign and difficult to treat.

When the spots emerge, if they are sparse on the head and face, absent on the chest and back, with reddish-pink roots, pointed tops that feel rough to the touch, and glistening like water droplets, this is an auspicious omen requiring no medication.

If during emergence there is restlessness, unceasing lower back and abdominal pain, foul breath, and purple spots appear, death ensues. Similarly, if blue-green spots resembling indigo dye appear, these are also fatal signs.

If the emerging spots are pale white, thin-skinned, and glossy, with roots completely lacking redness or having only a slight red tint, and growing to the size of mung beans within three to five days, these pustules will definitely not fill with pus. Later, they become sacs filled with clear fluid; if ruptured, death follows. Do not administer drugs rashly just because they look aesthetically pleasing.

If the emerging spots fail to form a peak entirely, or if the peaks resemble blisters or burnt rush stems, death occurs after ten days due to itching and collapse.

If red patterns resembling brocade appear upon emergence, death occurs on the sixth day; if the entire body resembles snake skin, death ensues.

If the spots are black like moles, with muscles forming black clumps, death occurs on the same day.

If the body fever does not penetrate thoroughly, yet spots immediately appear on the surface, then vanish, reappear, and vanish again, this is called "Nongbiao Smallpox" (Playing-with-Surface Smallpox). Smallpox relies entirely on thorough heat penetration to ensure smooth skin channels and easy eruption. Since the heat is not penetrating, akin to immature soil, the spots emerge and disappear, hide and re-emerge. This indicates extreme depletion of Qi and Blood, lacking the strength to vent the pathogen, making it difficult to treat.

If the pustule color is red-purple, scorched, and dry, adhering tightly to the skin without rising, with thick black skin like iron that cannot be pierced, and lacking pus or blood, this is termed "Iron Armor Smallpox." It results from stagnant Qi failing to nourish and depleted Blood failing to moisten, with pathogenic factors pressing against the skin and flesh, leading to death within eight to nine days.

Once all pustules have emerged and are about to rise, if blood blisters appear, this indicates toxin latent in the Heart, leading to immediate death. If water blisters appear, this indicates toxin latent in the Liver, leading to death shortly after itching and collapse occur.